Role of Surgery in the Management of Hepatic Diseases

**103**

**Chapter 6**

**Abstract**

**1. Introduction**

Ischemic Preconditioning Directly

or Remotely Applied on the Liver

to Reduce Ischemia-Reperfusion

*Maria Eugenia Cornide-Petronio, Mónica B. Jiménez-Castro,* 

Ischemia-reperfusion (I/R) injury is an important cause of liver damage occur-

transaminasemia and liver function failure. In liver transplantation, I/R causes graft dysfunction, ranging from biochemical abnormalities to primary non-function of the transplanted organ. Ischemic preconditioning is a surgical strategy to reduce the severity of I/R and improve post-operative outcomes by prior exposure to a brief period of vascular occlusion directly to the target organ or remotely to a distant vascular bed. This chapter aims to discuss the different ischemic preconditioning strategies in both liver resection surgery and liver transplantation. In addition, we will describe the differences of such surgical strategies in both steatotic and nonsteatotic livers in both preclinical experiments and clinical practice. Such information may be useful to guide the design of the effective ischemic preconditioning

ring during surgical procedures. In liver resection, I/R causes post-operative

methods in the surgery of hepatic resections and liver transplantation.

ischemic preconditioning, remote ischemic preconditioning

**Keywords:** ischemia-reperfusion injury, liver resections, liver transplantation,

Ischemia-reperfusion (I/R) injury is a phenomenon in which cellular damage in a hypoxic organ is accentuated following the oxygen restoration [1–3], being a major pathophysiological event and cause of morbidity and mortality in liver resections and transplantation [4]. Despite the attempts to solve this problem, hepatic I/R is an unresolved problem. In addition, hepatic steatosis is a major risk factor for liver surgery, as it is associated with an increased complication index and postoperative mortality after major liver resection and transplantation, since steatotic livers show impaired regenerative response and reduced tolerance to I/R injury compared with non-steatotic ones. Of note, the prevalence of steatosis ranges from 24 to 45%

Injury in Resections and

*Jordi Gracia-Sancho and Carmen Peralta*

Transplantation
