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Preconditioning, organ preservation, and postconditioning to prevent ischemia‐reperfusion injury to the liver
Author(s) -
de Rougemont Olivier,
Lehmann Kuno,
Clavien PierreAlain
Publication year - 2009
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21876
Subject(s) - medicine , ischemia , liver transplantation , reperfusion injury , ischemic preconditioning , perfusion , resection , liver injury , organ transplantation , surgery , transplantation , anesthesia , intensive care medicine , cardiology
Ischemia and reperfusion lead to injury of the liver. Ischemia‐reperfusion injury is inevitable in liver transplantation and trauma and, to a great extent, in liver resection. This article gives an overview of the mechanisms involved in this type of injury and summarizes protective and treatment strategies in clinical use today. Intervention is possible at different time points: during harvesting, during the period of preservation, and during implantation. Liver preconditioning and postconditioning can be applied in the transplant setting and for liver resection. Graft optimization is merely possible in the period between the harvest and the implantation. Given that there are 3 stages in which a surgeon can intervene against ischemia‐reperfusion injury, we have structured the review as follows. The first section reviews the approaches using surgical interventions, such as ischemic preconditioning, as well as pharmacological applications. In the second section, static organ preservation and machine perfusion are addressed. Finally, the possibility of treating the recipient or postconditioning is discussed. Liver Transpl 15:1172–1182, 2009. © 2009 AASLD.