Effect of remote ischemic preconditioning on hepatic ischemia-reperfusion injury in patients undergoing liver resection: a randomized controlled trial

BACKGROUND: Studies in animal models have shown that remote ischemic preconditioning (RIPC) could protect the liver from hepatic ischemia-reperfusion injury (HIRI). The aim of this study was to examine whether RIPC could reduce HIRI in patients undergoing liver resection. METHODS: A total of 120 patients were randomly assigned to three groups: a control group receiving no conditioning, an ischemic preconditioning (IPC) group, and an RIPC group. In the IPC group, the hepatoduodenal ligament was blocked for 10 min followed by 10 min of reperfusion prior to hepatic resection. Patients in the RIPC group received three cycles of 5-min ischemia followed by 5-min reperfusion to the right arm. Alanine transaminase (ACT), aspartate transaminase (AST), and tumor necrosis factor-like weak inducer of apoptosis (TWEAK) were examined before and after surgery. RESULTS: A total of 105 patients completed the trial: 39 in the control group, 32 in the IPC group, and 34 in the RIPC group. In comparison to the control. serum ALT and AST levels significantly decreased in the IPC (ALT: 507.0 +/- 401.3 vs. 1040.7 +/- 649.5 IU/L, P<0.001; AST: 495.8 +/- 369.4 vs. 935.9 +/- 640.7 IU/L, P=0.001) and RIPC (ALT: 680.8 +/- 291.5 vs. 1040.7 +/- 649.5 IU/L, P=0.002; AST: 661.7 +/- 290.6 vs. 935.9 +/- 640.7 IU/L, P=0.014) groups on the first postoperative day. In comparison to the control, TWEAK significantly decreased in the IPC group (IPC 57.99 +/- 17.8 vs. control 76.13 +/- 12.4 ng/L, P=0.025) after surgery. TWEAK did not differ between the RIPC and IPC groups (RIPC 64.84 +/- 14.2 vs. IPC 57.99 +/- 17.8 ng/L, P=0.385). CONCLUSIONS: RIPC could reduce hepatic ischemia-reperfusion injury after liver resection.