Impact of preoperative steroids administration on ischemia-reperfusion injury and systemic responses in liver surgery: A prospective randomized study

Authors

  • Luca Aldrighetti,

    Corresponding author
    1. Department of Surgery–Liver Unit, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Milano, Italy
    • Department of Surgery–Liver Unit, Scientific Institute H San Raffaele, Via Olgettina 60, 20132 Milano, Italy
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    • Telephone: 39-02-2643-7808; FAX: 39-02-2643-7807

  • Carlo Pulitanò,

    1. Department of Surgery–Liver Unit, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Milano, Italy
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  • Marcella Arru,

    1. Department of Surgery–Liver Unit, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Milano, Italy
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  • Renato Finazzi,

    1. Department of Surgery–Liver Unit, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Milano, Italy
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  • Marco Catena,

    1. Department of Surgery–Liver Unit, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Milano, Italy
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  • Laura Soldini,

    1. LaboRaf Diagnostic and Research, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Milano, Italy
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  • Laura Comotti,

    1. Department of Anaesthesiology, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Milano, Italy
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  • Gianfranco Ferla

    1. Department of Surgery–Liver Unit, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Milano, Italy
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Abstract

Hepatic injury secondary to warm ischemia-reperfusion (I/R) injury and alterations in haemostatic parameters are often unavoidable events after major hepatic resection. The release of inflammatory mediator is believed to play a significant role in the genesis of these events. It has been suggested that preoperative steroid administration may reduce I/R injury and improve several aspects of the surgical stress response. The aim of this prospective randomized study was to investigate the clinical benefits on I/R injury and systemic responses of preoperatively administered corticosteroids. Seventy-six patients undergoing liver resection were randomized either to a steroid group or to a control group. Patients in the steroid group received preoperatively 500 mg of methylprednisolone. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, coagulation parameters, and inflammatory mediators, interleukin 6 and tumor necrosis factor alpha were compared between the 2 groups. Length of stay, and type and number of complications were recorded as well. Postoperative serum levels of ALT, AST, total bilirubin, and inflammatory cytokines were significantly lower in the steroid than in the control group at postoperative days 1 and 2. Changes in hemostatic parameters were also significantly attenuated in the steroid group. In conclusion, the incidence of postoperative complications in the steroid group tended to be significantly lower than the control group. It is of clinical interest that preoperative steroids administration before major surgery may reduce I/R injury, maintain coagulant/anticoagulant homeostasis, and reduce postoperative complications by modulating the inflammatory response. Liver Transpl 12:941–949, 2006. © 2006 AASLD.

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