99 Ischemic preconditioning during donor procurement in orthotopic liver transplantation. Preliminary results of a prospective and randomized trial

Ischemic preconditioning in deceased donor liver transplantation: A prospective randomized clinical trial of safety and efficacy

“…Considerable research in experimental animals has shown that a brief period of hepatic inflow occlusion effectively induces hepatic IPC and is protective against RP injury after both cold and warm ischemia 11, 15–17. Except for a very recent abstract of a presentation, there is no data in the literature regarding the clinical application of this protective phenomenon in human deceased donor liver transplantation 20. The salient findings of our study are: 1) deceased organ donors, despite being hemodynamically labile and frequently requiring vasopressors, tolerated 5 minutes of hepatic hilar clamping well, when this was performed before the performance of extensive intraperitoneal dissection; and 2) in deceased donor liver transplantation, 5 minutes of hilar clamping during liver recovery, as performed in this study, did not induce IPC.…”

“…We have recently begun a new study with 10 minutes of hilar clamping. However, the need for tempering of expectations is demonstrated by the very recent report of Amador et al20 of a study of 53 deceased liver donors randomized either to standard organ recovery or to 10 minutes of hilar clamping. Preliminary data from that study showed no induction of IPC.…”

“…To our knowledge, the feasibility and efficacy of hepatic IPC has not been reported in deceased donor liver transplantation in man except in a very recent abstract 20. Deceased organ donors are hemodynamically labile and frequently require 1 or more vasopressors.…”

Ischemic preconditioning of the liver: A few perspectives from the bench to bedside translation

“…In an abstract report of 53 DDLTs, Amador et al 22 reported that 10 minutes of IPC increased RP injury in a subset of "good" donors. However, a recent publication of that trial data did not address this issue of the IPC paradox.…”

“…Subsequently, others have reported results of clinical trial in LR and in deceased donor liver transplantation (DDLT). [21][22][23][24][25][26][27][28][29] It is fair to conclude that the overall clinical results have been less stellar than what was observed in experimental animals. Therefore, a critical evaluation of the available evidence from the initial translational attempts is needed.…”