Effects of remote ischemic preconditioning on liver injury following hepatectomy: a systematic review and meta-analysis of randomized control trials

Zhang, Hao; Zhang, Ting; Zhong, Furui

doi:10.1007/s00595-020-02205-1

Cited by 6 publications

(4 citation statements)

References 36 publications

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“…The first systematic review [ 16 ] on this topic was published online in January 2021, and included seven studies with a total of 459 patients. The evaluation results showed that ALT and AST levels on POD 1 in the RIPC group were lower.…”

Section: Discussionmentioning

confidence: 99%

“…Even though RIPC has been shown to have hepatoprotective effects in several animal experiments [ 9 – 11 ], patient-based studies have shown controversial results [ 12 – 14 ]. Only two systematic reviews on this topic were found in the literature [ 15 , 16 ], both of which contained fewer studies and less data than this study. In addition, one mistakenly included patients with remote ischemic postconditioning (RIpostC) in the meta-analysis, and the other included a randomized controlled trial (RCT) of liver transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

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Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis

Tian,

Wang,

Huang

et al. 2024

BMC Anesthesiol

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Background Animal experiments have confirmed that remote ischemic preconditioning (RIPC) can reduce hepatic ischemia-reperfusion injuries (HIRIs), significantly improving early tissue perfusion and oxygenation of the residual liver after resections, accelerating surgical prognoses, and improving survival rates. However, there is still controversy over the role of RIPC in relieving HIRI in clinical studies, which warrants clarification. This study aimed to evaluate the beneficial effects and applicability of RIPC in hepatectomy and to provide evidence-based information for clinical decision-making. Methods Randomized controlled trials (RCTs) evaluating the efficacy and safety of RIPC interventions were collected, comparing RIPC to no preconditioning in patients undergoing hepatectomies. This search spanned from database inception to January 2024. Data were extracted independently by two researchers according to the PRISMA guidelines. The primary outcomes assessed were postoperative alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), and albumin (ALB) levels. The secondary outcomes assessed included duration of surgery and Pringle, length of postoperative hospital stay, intraoperative blood loss and transfusion, indocyanine green (ICG) clearance, hepatocyte apoptosis index, postoperative complications, and others. Results Ten RCTs were included in this meta-analysis, with a total of 865 patients (428 in the RIPC group and 437 in the control group). ALT levels in the RIPC group were lower than those in the control group on postoperative day (POD) 1 (WMD = − 59.24, 95% CI: − 115.04 to − 3.45; P = 0.04) and POD 3 (WMD = − 27.47, 95% CI: − 52.26 to − 2.68; P = 0.03). However, heterogeneities were significant (I2 = 89% and I2 = 78%), and ALT levels on POD 3 were unstable based on a sensitivity analysis. AST levels on POD 1 in the RIPC group were lower than those in the control group (WMD = − 50.03, 95% CI: - 94.35 to − 5.71; P = 0.03), but heterogeneity was also significant (I2 = 81%). A subgroup analysis showed no significant differences in ALT and AST levels on POD 1 between groups, regardless of whether the Pringle maneuver or propofol was used for anesthesia (induction only or induction and maintenance, P > 0.05). The remaining outcome indicators were not statistically significant or could not be analyzed due to lack of sufficient data. Conclusion RIPC has some short-term liver protective effects on HIRIs during hepatectomies. However, there is still insufficient evidence to encourage its routine use to improve clinical outcomes. Trial registration The protocol of this study was registered with PROSPERO (CRD42022333383).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis

Tian,

Wang,

Huang

et al. 2024

BMC Anesthesiol

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“…Numerous strategies have been designed for reducing liver injury and postoperative inflammatory response, and preserving liver function during hepatectomy (23,24). For instance, studies have suggested that remote ischemia preconditioning (RIPC) could effectively reduce hepatic IRI after liver resection.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine ameliorates liver injury and maintains liver function in patients with hepatocellular carcinoma after hepatectomy: a retrospective cohort study with propensity score matching

Wang

Shi

et al. 2023

Front. Oncol.

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BackgroundAlthough dexmedetomidine (DEX) is widely used during the perioperative period in patients with hepatocellular carcinoma (HCC), its clinical effects on liver function and postoperative inflammation are unclear. This study aimed to explore effects of DEX on postoperative liver function and inflammation in patients with HCC after hepatectomy.MethodsA retrospective cohort study with propensity score matching was performed. A total of 494 patients who underwent hepatectomy from June 2019 to July 2020 and fulfilled the eligibility criteria were included in this study. Baseline data, liver function indexes and inflammation-related biomarkers were collected and compared between the two groups. Survival analysis was conducted to investigate the effects of DEX on the overall survival (OS) of patients. Propensity score matching (PSM) was used to minimize bias between the two groups.ResultsThe study cohort comprised 189 patients in the DEX-free group and 305 patients in the DEX group. Patients in the DEX group had lower levels of alanine transaminase (ALT, P = 0.018) and lactate dehydrogenase (LDH, P = 0.046) and higher level of serum albumin (ALB, P < 0.001) than patients in the DEX-free group before discharge. A total of 107 pairs of patients were successfully matched by PSM. Results consistently suggested that ALT and LDH levels were significantly lower (P = 0.044 and P = 0.046, respectively) and ALB levels were significantly higher (P = 0.002) in the DEX group than in the DEX-free group in the early postoperative period. No significant differences of inflammation-related biomarkers were observed between two groups after PSM. Neither the Kaplan–Meier survival analysis nor the multiple Cox regression survival analysis identified DEX as a contributing factor that would affect the OS of patients after PSM.ConclusionDEX exerts protective effects on liver function while has little effects on inflammation-related biomarkers in the early postoperative period in patients undergoing hepatectomy due to HCC.

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“…However, evidence from human studies is inconclusive, and most trials do not report long-term outcomes. Recent meta-analyses of RCTs failed to identify convincing evidence that remote IPC reduces IRI during liver resection 217 or transplantation, 218 while direct IPC has been shown to lower postoperative AST levels, 218 a possible surrogate of IRI, after transplantation. Well-designed studies with long-term endpoints are needed to confirm these preliminary results.…”

Section: Therapeutic Options ( Box 4 )mentioning

confidence: 99%

The role of ischaemia-reperfusion injury and liver regeneration in hepatic tumour recurrence

et al. 2023

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Effects of remote ischemic preconditioning on liver injury following hepatectomy: a systematic review and meta-analysis of randomized control trials

Cited by 6 publications

References 36 publications

Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis

Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis

Dexmedetomidine ameliorates liver injury and maintains liver function in patients with hepatocellular carcinoma after hepatectomy: a retrospective cohort study with propensity score matching

The role of ischaemia-reperfusion injury and liver regeneration in hepatic tumour recurrence

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