Liver Ischaemia Reperfusion (IR) injury is a major cause of post-operative liver dysfunction,\nmorbidity and mortality following liver resection surgery and transplantation. There are no proven\ntherapies for IR injury in clinical practice and new approaches are required. Ischaemic Preconditioning\n(IPC) can be applied in both a direct and remote fashion and has been shown to ameliorate IR injury\nin small animal models. Its translation into clinical practice has been difficult, primarily by a lack of\nknowledge regarding the dominant protective mechanisms that it employs. A review of all current\nstudies would suggest that IPC/RIPC relies on creating a small tissue injury resulting in the release\nof adenosine and L-arginine which act through the Adenosine receptors and the haem-oxygenase\nand endothelial nitric oxide synthase systems to reduce hepatocyte necrosis and improve the hepatic\nmicrocirculation post reperfusion. The next key step is to determine how long the stimulus requires\nto precondition humans to allow sufficient injury to occur to release the potential mediators. This\nwould open the door to a new therapeutic chapter in this field.
Loading....