Remote Organ Ischemic Preconditioning In Human Recipients Suppresses Systemic Inflammation And Prevents Glycocalyx Degradation In Living-Donor Liver Transplantation; A Randomised Controlled Trial
Melis Tosun, Meltem Güner Can, Uğur Aksu, Remzi Emiroğlu, Fevzi Toraman
Aksaray Training and Research Hospital, Department of Anesthesiology and Reanimation, Aksaray, Turkey
Giriş:
Ischemia-reperfusion (IR) injury during liver transplantation is a leading cause of morbidity and mortality. Although there is no standard strategy to reduce IR injury, ischemic
preconditioning (IP) and remote organ ischemic preconditioning (RIPC) are among the most researched methods. The objective of this study was to demonstrate the early effects of
RIPC on living-donor liver recipients in terms of systemic inflammation parameters (TNF-alpha, ICAM-1, HIF-1, and IL-8) and glycocalyx integrity parameters (SDC-1, sVCAM-1).
Gereç ve Yöntem: Twenty-one patients who underwent elective living-donor liver transplantation were randomized into two groups: the RIPC group (n=10) and the control group (n=11). An orthopaedic tourniquet was wrapped around the right lower extremities of the patients in the RIPC group and was performed before the anhepatic phas. All five parameters were measured at three different time points in all patients.
Bulgular: The levels of TNF-alpha, ICAM-1, and HIF-1 were found to be significantly higher in the control group than in the RIPC group (P<0.01, P<0.05, and P<0.05, respectively), but there was no difference in the IL-8 levels between the groups (P>0.05). The levels of SDC-1 and ICAM-1 were found to be significantly higher in the control group than in the RIPC group (P<0.05 and P<0.05, respectively).
Tartışma ve Sonuç: In conclusion, RIPC is a method that can be easily applied in the clinic and since RIPC can be performed non-invasively, it eliminates the risks of arterial insufficiency and embolization secondary to arterial manipulation that may develop with IP. For the first time in a clinical setting, this study showed that RIPC has positive effects on systemic inflammation parameters in the early period and reduces glycocalyx damage. However, both advanced biochemical studies and clinical studies with larger samples are required to explain the mechanism of action of RIPC and to develop optimized preconditioning protocols.
|