**4. Conclusion**

Surgical strategies such as the induction of IPC or RIPC could be of clinical interest in human liver resections and liver transplantation in both steatotic and non-steatotic livers. Both IPC and RIPC are easy to apply, inexpensive and does not require the use of drugs with potential side effects, but it requires a period of pre-ischemic manipulation for organ protection. These preconditioning techniques have been demonstrated to be promising tools for the reduction of hepatic I/R injury in different warm and cold ischemia models. Therefore, the potential applications of IPC and RIPC in human liver surgery are numerous. The benefits of IPC and RIPC have been evidenced in patients submitted to partial hepatectomy in both steatotic and non-steatotic livers. In our view, IPC and RIPC could resolve, at least partially, the lack of liver grafts available for transplant, since it can improve the post-operative outcome of liver grafts from extended criteria donors. However, controversial results on the effects of IPC and RIPC have been reported in the clinical practice of liver transplantation. It should be considered that the underlying mechanisms of both IPC and RIPC and their relevance in liver surgery remain poorly understood. Indeed, as stated along this chapter, most of the experimental studies have been focused on the molecular changes occurring during IPC and RIPC in non-brain-dead donors. Moreover, most of the experimental studies of IPC and RIPC have been performed only in I/R injury models, without hepatic resections or liver transplantation. The tolerance to I/R injury induced by either IPC or RIPC is dependently of the number of cycles of I/R and their duration as well as the surgical procedures. The clinical application of strategies designed at benchside will depend on the use of experimental models of IPC and RIPC that resemble as much as possible the clinical conditions. Multidisciplinary research groups should devote additional efforts to better understand the molecular mechanisms of IPC and RIPC

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provided the original work is properly cited.

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Ischemic Preconditioning Directly or Remotely Applied on the Liver to Reduce…*

during the different clinical liver surgery setting to ultimately develop useful surgi-

This research was supported by the Ministerio de Economía y Competitividad

(FondosFeder, "una manera de hacer Europa"); by CERCA Program/Generalitat de Catalunya; by the Secretaria d'Universitats i Recerca (Grant 2017SGR-551) Barcelona, Spain. J Gracia-Sancho received continuous funding from the Instituto de Salud Carlos III (currently FIS PI17/00012) and the CIBEREHD, from Ministerio

Maria Eugenia Cornide-Petronio1†, Mónica B. Jiménez-Castro2†, Jordi Gracia-Sancho3

1 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona,

Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Centro de Investigaciones Biomédicas en Red en Enfermedades Hepáticas y Digestivas

5 Facultad de Medicina, Universidad International de Cataluña, Barcelona, Spain

3 Barcelona Hepatic Hemodynamic Laboratory, Institut d'Investigacions

4 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y

(project grant SAF-2015-64857-R) Madrid, Spain; the European Union

The authors declare that they have no conflict of interest.

*DOI: http://dx.doi.org/10.5772/intechopen.86148*

cal strategies aimed at reducing I/R damage.

de Ciencia, Innovación y Universidades.

2 Transplant Biomedicals, S.L., Barcelona, Spain

**Acknowledgements**

**Conflict of interest**

**Author details**

Spain

and Carmen Peralta1,4,5\*

(CIBEREHD), Barcelona, Spain

Digestivas (CIBEREHD), Barcelona, Spain

\*Address all correspondence to: cperalta@clinic.ub.es

† Both authors contributed equally to this work.

*Ischemic Preconditioning Directly or Remotely Applied on the Liver to Reduce… DOI: http://dx.doi.org/10.5772/intechopen.86148*

during the different clinical liver surgery setting to ultimately develop useful surgical strategies aimed at reducing I/R damage.
