This paper is a shortened and combined version of two Cochrane reviews submitted to the Cochrane Hepato-Biliary Group.
Systematic review of randomized controlled trials of pharmacological interventions to reduce ischaemia-reperfusion injury in elective liver resection with vascular occlusion
Article first published online: 5 OCT 2009
© 2009 International Hepato-Pancreato-Biliary Association
Volume 12, Issue 1, pages 4–14, February 2010
How to Cite
Abu-Amara, M., Gurusamy, K., Hori, S., Glantzounis, G., Fuller, B. and Davidson, B. R. (2010), Systematic review of randomized controlled trials of pharmacological interventions to reduce ischaemia-reperfusion injury in elective liver resection with vascular occlusion. HPB, 12: 4–14. doi: 10.1111/j.1477-2574.2009.00120.x
- Issue published online: 11 JAN 2010
- Article first published online: 5 OCT 2009
- Received 16 May 2009; accepted 9 July 2009
- ischaemia-reperfusion injury;
- liver resection;
- pharmacological drugs;
- vascular occlusion
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.