Systematic review of randomized controlled trials of pharmacological interventions to reduce ischaemia-reperfusion injury in elective liver resection with vascular occlusion

Authors

  • Mahmoud Abu-Amara,

    Corresponding author
    1. Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, Royal Free Hospital Campus, London, UK and
      M. Abu-Amara, c/o Professor B. R. Davidson, University Department of Surgery, 9th Floor, Royal Free Hospital, Pond Street, London NW3 2QG, UK. Tel: + 44 207 794 0500 (ext 33603). Fax: + 44 207 830 2688. E-mail: m_abu_amara@hotmail.com
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  • Kurinchi Gurusamy,

    1. Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, Royal Free Hospital Campus, London, UK and
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  • Satoshi Hori,

    1. Department of Urology, Addenbrooke's Hospital, Cambridge, UK
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  • George Glantzounis,

    1. Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, Royal Free Hospital Campus, London, UK and
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  • Barry Fuller,

    1. Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, Royal Free Hospital Campus, London, UK and
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  • Brian R. Davidson

    1. Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, Royal Free Hospital Campus, London, UK and
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  • This paper is a shortened and combined version of two Cochrane reviews submitted to the Cochrane Hepato-Biliary Group.

M. Abu-Amara, c/o Professor B. R. Davidson, University Department of Surgery, 9th Floor, Royal Free Hospital, Pond Street, London NW3 2QG, UK. Tel: + 44 207 794 0500 (ext 33603). Fax: + 44 207 830 2688. E-mail: m_abu_amara@hotmail.com

Abstract

Background:  Vascular occlusion during liver resection results in ischaemia-reperfusion (IR) injury, which can lead to liver dysfunction. We performed a systematic review and meta-analysis to assess the benefits and harms of using various pharmacological agents to decrease IR injury during liver resection with vascular occlusion.

Methods:  Randomized clinical trials (RCTs) evaluating pharmacological agents in liver resections conducted under vascular occlusion were identified. Two independent reviewers extracted data on population characteristics and risk of bias in the trials, and on outcomes such as postoperative morbidity, hospital stay and liver function.

Results:  A total of 18 RCTs evaluating 17 different pharmacological interventions were identified. There was no significant difference in perioperative mortality, liver failure or postoperative morbidity between the intervention and control groups in any of the comparisons. A significant improvement in liver function was seen with methylprednisolone use. Hospital and intensive therapy unit stay were significantly shortened with trimetazidine and vitamin E use, respectively. Markers of liver parenchymal injury were significantly lower in the methylprednisolone, trimetazidine, dextrose and ulinastatin groups compared with their respective controls (placebo or no intervention).

Discussion:  Methylprednisolone, trimetazidine, dextrose and ulinastatin may have protective roles against IR injury in liver resection. However, based on the current evidence, they cannot be recommended for routine use and their application should be restricted to RCTs.

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