Objective

Novel hepatoprotective strategies are needed to improve clinical outcomes during liver surgery. There is mixed data on the role of remote ischemic preconditioning (RIPC). We investigated RIPC in partial hepatectomy for primary hepatocellular carcinoma (HCC).

Methods

This was a Phase II, single-center, sham-controlled, randomized controlled trial (RCT). The primary hypothesis was that RIPC would reduce acute liver injury following surgery indicated by serum alanine transferase (ALT) 24 h following hepatectomy in patients with primary HCC, compared to sham. Patients were randomized to receive either four cycles of 5 min/5 min arm cuff inflation/deflation immediately prior to surgery, or sham. Secondary endpoints included clinical, biochemical and pathological outcomes. Liver function measured by Indocyanine Green pulse densitometry was performed in a subset of patients.

Results

24 and 26 patients were randomized to RIPC and control groups respectively. The groups were balanced for baseline characteristics, except the duration of operation was longer in the RIPC group. Median ALT at 24 h was similar between groups (196 IU/L IQR 113.5–419.5 versus 172.5 IU/L IQR 115–298 respectively, p = 0.61). Groups were similar in secondary endpoints.

Conclusion

This RCT did not demonstrate beneficial effects with RIPC on serum ALT levels 24 h after partial hepatectomy.

中文翻译：

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远程缺血预处理对肝切除术患者肝损伤的影响：ERIC-LIVER 试验。

客观的

需要新的保肝策略来改善肝脏手术期间的临床结果。关于远程缺血预处理 (RIPC) 的作用，数据不一。我们研究了 RIPC 在原发性肝细胞癌 (HCC) 部分肝切除术中的应用。

方法

这是一项 II 期、单中心、假对照、随机对照试验 (RCT)。主要假设是，与假手术相比，RIPC 将减少原发性 HCC 患者肝切除术后 24 小时血清丙氨酸转移酶 (ALT) 指示的手术后急性肝损伤。患者随机接受手术前立即进行 5 分钟/5 分钟臂套充气/放气的四个周期或假手术。次要终点包括临床、生化和病理结果。在一部分患者中进行了通过吲哚菁绿脉冲密度测定法测量的肝功能。

结果

24 名和 26 名患者分别被随机分配到 RIPC 组和对照组。除了 RIPC 组的手术持续时间更长之外，各组的基线特征是平衡的。组间 24 小时的中位 ALT 相似（分别为 196 IU/L IQR 113.5–419.5 和 172.5 IU/L IQR 115–298，p = 0.61）。各组在次要终点方面相似。

结论

该 RCT 并未证明 RIPC 对部分肝切除术后 24 小时的血清 ALT 水平有益。