Comparing the protective effects of local and remote ischemic preconditioning against ischemia-reperfusion injury in...

Area of Science:

• Hepatobiliary surgery
• Ischemic preconditioning
• Liver transplantation

Background:

• Hepatic ischemia-reperfusion injury (HIRI) is a risk during hepatectomy.
• Local ischemic preconditioning (LIPC) and remote ischemic preconditioning (RIPC) show potential for mitigating HIRI.
• Direct comparisons of LIPC and RIPC efficacy in liver resection are limited.

Purpose of the Study:

• To compare the efficacy of LIPC and RIPC in reducing hepatic injury during liver resection.
• To evaluate the impact of these preconditioning strategies on postoperative liver function and surgical outcomes.

Main Methods:

• A network meta-analysis was conducted, searching multiple databases (Cochrane, PubMed, Embase, CNKI) up to January 2023.
• Included randomized clinical trials (RCTs) comparing LIPC, RIPC, or no preconditioning in liver resection.
• Analyzed postoperative liver function (serum transaminases) and surgical events using standardized mean differences (SMDs) and odds ratios (ORs).

Main Results:

• 26 RCTs with 1,476 participants were analyzed.
• Both LIPC and RIPC significantly reduced postoperative aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels compared to no preconditioning.
• No significant differences in liver function or surgical outcomes were found between LIPC and RIPC.

Conclusions:

• Both RIPC and LIPC are effective strategies for alleviating HIRI during hepatectomy.
• While no significant difference exists between RIPC and LIPC, RIPC presents as a more easily applicable option.
• Subgroup analysis suggests RIPC may offer particular benefits for patients with cirrhosis or those undergoing major resections.