Advantage of ischemic preconditioning for hepatic resection in pigs |
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Authors: | Kadono Jun Hamada Nobuo Fukueda Mikio Ishizaki Naoki Kaieda Mamoru Gejima Kentaro Nishida Seigo Nakamura Kazuo Yoshida Hiroki Sakata Ryuzo |
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Affiliation: | Second Department of Surgery, Faculty of Medicine, Kagoshima University, Sakuragaoka, Kagoshima, Japan. kadonofamily@k6.dion.ne.jp |
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Abstract: | BACKGROUND: Ischemic preconditioning (IP) and intermittent inflow occlusion (IO) have provided beneficial outcomes in hepatic resection. However, comparison of these two procedures against warm hepatic ischemia-reperfusion injury has not been studied enough. MATERIALS AND METHODS: Pigs that had undergone 65% hepatectomy were subjected to Control (120 min continuous ischemia, n = 6), IP (10 min ischemia and 10 min reperfusion, followed by 120 min continuous ischemia, n = 6), and IO (120 min ischemia in the form of eight successive periods of 15 min ischemia and 5 min reperfusion, n = 6). We evaluated hepatocyte injury by aspartate aminotransferase, lactate dehydrogenase and hepaplastin test, hepatic microcirculation by hepatic tissue blood flow (HTBF) and endothelin (ET)-1, inflammatory response by tumor necrosis factor-alpha (TNF-alpha), and histopathology after reperfusion. RESULTS: IP prevented hepatocyte injury, HTBF disturbance, and hepatocyte necrosis in histopathology as well as IO. These two groups showed significantly better outcomes than Control. IP produced significantly less ET-1 and TNF-alpha than IO. CONCLUSIONS: IP ameliorated hepatic warm ischemia-reperfusion injury. Furthermore, IP gained more advantages in preventing chemokine production such as ET-1 and inflammatory response over IO. IP could take the place of IO for hepatectomy. |
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Keywords: | ischemic preconditioning intermittent occlusion ischemia-reperfusion injury hepatic resection |
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