RESUMO
BACKGROUND: Hepatic surgery requires, under diverse circumstances, periods of ischemia and reperfusion (I-R) such as those present in liver resection, hepatic injury, and liver transplantation. The objective of the present work was to conduct an experimental study to evaluate the effect of hepatic preconditioning (HPC) on modulation of the I-R injury. METHODS: Male Wistar rats were distributed into the following three study groups: group 1, simulated or sham; group 2, submitted to a 30-min period of total warm ischemia and a reperfusion phase, and group 3, in which we carried out 10-min preconditioning of warm ischemia and 10 min of reperfusion prior to the total ischemia period for a total of 60 min and the reperfusion phase. We obtained liver biopsies for thiobarbituric acid reactive substances (TBARS) (MDA, thiobarbituric acid adducts) and for blood sample determinations in serum of liver-cell enzymes such as alanine aminotransferase and aspartate aminotransferase during a 24-h time course. RESULTS: We observed a decrease in the variables studied in group 3 (HPC) as well as of serum liver enzymes and TBARS levels such as indirect oxidative stress indicators upon comparison with group 2 animals submitted to total hepatic I-R. CONCLUSIONS: HPC is an efficient surgical strategy for decreasing the elevation of hepatic enzymes and indirect lipoperoxidation indicators in an I-R model. Controlled clinical studies should be performed to determine its functional properties and clinical applicability.
Assuntos
Hepatectomia/métodos , Precondicionamento Isquêmico , Peroxidação de Lipídeos , Fígado/irrigação sanguínea , Traumatismo por Reperfusão/prevenção & controle , Substâncias Reativas com Ácido Tiobarbitúrico/análise , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Hepatectomia/efeitos adversos , L-Lactato Desidrogenase/sangue , Fígado/química , Fígado/enzimologia , Masculino , Estresse Oxidativo , Distribuição Aleatória , Ratos , Ratos Wistar , Isquemia QuenteRESUMO
INTRODUCTION: The purpose of this review is to summarize intraoperative surgical strategies available to decrease ischemia-reperfusion injury associated with liver resection and liver transplantation. MATERIAL AND METHOD: We conducted a critical review of the literature evaluating the potential applications of hepatic ischemic preconditioning (IPC) for hepatic resection surgery and liver transplantation. In addition, we provide a basic bench-to-bedside summary of the liver physiology and cell signaling mechanisms that account for the protective effects seen with hepatic IPC.