Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis
Abstract Background Animal experiments have confirmed that remote ischemic preconditioning (RIPC) can reduce hepatic ischemia-reperfusion injuries (HIRIs), significantly improving early tissue perfusion and oxygenation of the residual liver after resections, accelerating surgical prognoses, and impr...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-03-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-024-02506-9 |
| _version_ | 1797233300815740928 |
|---|---|
| author | Chun Tian Aihua Wang He Huang Youwan Chen |
| author_facet | Chun Tian Aihua Wang He Huang Youwan Chen |
| author_sort | Chun Tian |
| collection | DOAJ |
| description | Abstract Background Animal experiments have confirmed that remote ischemic preconditioning (RIPC) can reduce hepatic ischemia-reperfusion injuries (HIRIs), significantly improving early tissue perfusion and oxygenation of the residual liver after resections, accelerating surgical prognoses, and improving survival rates. However, there is still controversy over the role of RIPC in relieving HIRI in clinical studies, which warrants clarification. This study aimed to evaluate the beneficial effects and applicability of RIPC in hepatectomy and to provide evidence-based information for clinical decision-making. Methods Randomized controlled trials (RCTs) evaluating the efficacy and safety of RIPC interventions were collected, comparing RIPC to no preconditioning in patients undergoing hepatectomies. This search spanned from database inception to January 2024. Data were extracted independently by two researchers according to the PRISMA guidelines. The primary outcomes assessed were postoperative alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), and albumin (ALB) levels. The secondary outcomes assessed included duration of surgery and Pringle, length of postoperative hospital stay, intraoperative blood loss and transfusion, indocyanine green (ICG) clearance, hepatocyte apoptosis index, postoperative complications, and others. Results Ten RCTs were included in this meta-analysis, with a total of 865 patients (428 in the RIPC group and 437 in the control group). ALT levels in the RIPC group were lower than those in the control group on postoperative day (POD) 1 (WMD = − 59.24, 95% CI: − 115.04 to − 3.45; P = 0.04) and POD 3 (WMD = − 27.47, 95% CI: − 52.26 to − 2.68; P = 0.03). However, heterogeneities were significant (I 2 = 89% and I 2 = 78%), and ALT levels on POD 3 were unstable based on a sensitivity analysis. AST levels on POD 1 in the RIPC group were lower than those in the control group (WMD = − 50.03, 95% CI: - 94.35 to − 5.71; P = 0.03), but heterogeneity was also significant (I 2 = 81%). A subgroup analysis showed no significant differences in ALT and AST levels on POD 1 between groups, regardless of whether the Pringle maneuver or propofol was used for anesthesia (induction only or induction and maintenance, P > 0.05). The remaining outcome indicators were not statistically significant or could not be analyzed due to lack of sufficient data. Conclusion RIPC has some short-term liver protective effects on HIRIs during hepatectomies. However, there is still insufficient evidence to encourage its routine use to improve clinical outcomes. Trial registration The protocol of this study was registered with PROSPERO (CRD42022333383). |
| first_indexed | 2024-04-24T16:13:59Z |
| format | Article |
| id | doaj.art-139e214b10324d59a41607b42bb8b055 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-24T16:13:59Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-139e214b10324d59a41607b42bb8b0552024-03-31T11:33:25ZengBMCBMC Anesthesiology1471-22532024-03-0124111310.1186/s12871-024-02506-9Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysisChun Tian0Aihua Wang1He Huang2Youwan Chen3Department of Anesthesiology, Yongchuan Hospital of Chongqing Medical UniversityDepartment of Critical Care Medicine, Chongqing Yongchuan District People’s HospitalDepartment of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical UniversityDepartment of Critical Care Medicine, Chongqing Yongchuan District People’s HospitalAbstract Background Animal experiments have confirmed that remote ischemic preconditioning (RIPC) can reduce hepatic ischemia-reperfusion injuries (HIRIs), significantly improving early tissue perfusion and oxygenation of the residual liver after resections, accelerating surgical prognoses, and improving survival rates. However, there is still controversy over the role of RIPC in relieving HIRI in clinical studies, which warrants clarification. This study aimed to evaluate the beneficial effects and applicability of RIPC in hepatectomy and to provide evidence-based information for clinical decision-making. Methods Randomized controlled trials (RCTs) evaluating the efficacy and safety of RIPC interventions were collected, comparing RIPC to no preconditioning in patients undergoing hepatectomies. This search spanned from database inception to January 2024. Data were extracted independently by two researchers according to the PRISMA guidelines. The primary outcomes assessed were postoperative alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), and albumin (ALB) levels. The secondary outcomes assessed included duration of surgery and Pringle, length of postoperative hospital stay, intraoperative blood loss and transfusion, indocyanine green (ICG) clearance, hepatocyte apoptosis index, postoperative complications, and others. Results Ten RCTs were included in this meta-analysis, with a total of 865 patients (428 in the RIPC group and 437 in the control group). ALT levels in the RIPC group were lower than those in the control group on postoperative day (POD) 1 (WMD = − 59.24, 95% CI: − 115.04 to − 3.45; P = 0.04) and POD 3 (WMD = − 27.47, 95% CI: − 52.26 to − 2.68; P = 0.03). However, heterogeneities were significant (I 2 = 89% and I 2 = 78%), and ALT levels on POD 3 were unstable based on a sensitivity analysis. AST levels on POD 1 in the RIPC group were lower than those in the control group (WMD = − 50.03, 95% CI: - 94.35 to − 5.71; P = 0.03), but heterogeneity was also significant (I 2 = 81%). A subgroup analysis showed no significant differences in ALT and AST levels on POD 1 between groups, regardless of whether the Pringle maneuver or propofol was used for anesthesia (induction only or induction and maintenance, P > 0.05). The remaining outcome indicators were not statistically significant or could not be analyzed due to lack of sufficient data. Conclusion RIPC has some short-term liver protective effects on HIRIs during hepatectomies. However, there is still insufficient evidence to encourage its routine use to improve clinical outcomes. Trial registration The protocol of this study was registered with PROSPERO (CRD42022333383).https://doi.org/10.1186/s12871-024-02506-9Remote ischemic preconditioningIschemia-reperfusion injuryHepatic ischemia-reperfusion injuryHepatectomyLiver resection |
| spellingShingle | Chun Tian Aihua Wang He Huang Youwan Chen Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis BMC Anesthesiology Remote ischemic preconditioning Ischemia-reperfusion injury Hepatic ischemia-reperfusion injury Hepatectomy Liver resection |
| title | Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis |
| title_full | Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis |
| title_fullStr | Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis |
| title_full_unstemmed | Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis |
| title_short | Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis |
| title_sort | effects of remote ischemic preconditioning in hepatectomy a systematic review and meta analysis |
| topic | Remote ischemic preconditioning Ischemia-reperfusion injury Hepatic ischemia-reperfusion injury Hepatectomy Liver resection |
| url | https://doi.org/10.1186/s12871-024-02506-9 |
| work_keys_str_mv | AT chuntian effectsofremoteischemicpreconditioninginhepatectomyasystematicreviewandmetaanalysis AT aihuawang effectsofremoteischemicpreconditioninginhepatectomyasystematicreviewandmetaanalysis AT hehuang effectsofremoteischemicpreconditioninginhepatectomyasystematicreviewandmetaanalysis AT youwanchen effectsofremoteischemicpreconditioninginhepatectomyasystematicreviewandmetaanalysis |