Protective effect of ischemic preconditioning against ischemia reperfusion injury after major hepatectomy using intermittent Pringle's maneuver in swine

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Aim : Although ischemic preconditioning(IPC) has been reported to protect liver injury after hepatectomy using continuous Pringle's maneuver, it has not been clarified whether IPC protects liver against injury after hepatectomy using intermittent Pringle's maneuver. Materials and Methods : Male white swines (BW:20〜28kg;n=10) were used. Laparotomy using by chevron incision was performed under general anesthesia. To prevent intestinal congestion during prolonged occlusion of the portal vein and hepatic artery, veno-veno bypass was created between the right internal jugular vein and the main splenic vein. Left hemihepatectomy (approximately, 40%) was performed under Pringle's maneuver (15 min-clamp and 5 min-release) during hepatic resection. IPC group (n=5) : livers were subjected to IPC (hepatic ischemia for 10 min followed by reperfusion for 10 min) before intermitted Pringle's maneuver. None IPC group (n=5) : livers were subjected to only intermitted Pringle's maneuver during hepatect … More omy. Liver damage after hepatectomy was evaluated between the two groups by monitoring hemodynamics and biochemical examination. Serum GOT,GPT,LDH, hyaluronic acid, lactic acid, NOx, TNF-alpha were mesured after reperfusion. Histological and apoptotic findings were also evaluated after reperfusion for 180 min. Statistical analysis was performed using ANOVA. All values are expressed as means ±SD. Result : There were no significant differences in body weight, blood loss, hemodynamics, Pringle's maneuver time and resected liver weight between the two groups. IPC significantly reduced serum transaminase level (GOT:IPC:135.8±13.5 vs non IPC:199±16.8 P=0.018) and plasma TNF-alpha level (IPC:225.3±60.1 vs non IPC:760.4±437.7,P=0.042). Although serum level of LDH, lactic acid, hyaluronic acid and NOx in IPC group were elevated less than those in non-IPC group, there were no statically significantly difference between the two groups. In hepatic tissue, TUNEL-positive cells were significantly reduced in the IPC group. In none LPC, nuclear chromatin condensation is present in the hepatocyte. Conclusions : IPC exerts a effect against reperfusion injury hepatectomy with intermitted Pringle's maneuver. Less