Background: In recent decades, liver transplantation (LTx) has increased the survival and quality of life of patients with end-stage organ failure. Unfortunately, LTx is limited due to the shortage of donors. A lot of effort is put into finding new ways to reduce ischemia-reperfusion injury (IRI) in liver grafts to increase the number of suitable organs procured from expanded-criteria donors (ECD). The aim of this study was to systematically review the literature reporting LTx outcomes when using ischemic preconditioning (IPC) or remote ischemic preconditioning (RIPC) to reduce IRI in liver grafts. Methods: A literature search was performed in the MEDLINE, Web of Science, and EMBASE databases. The following combination was used: “Liver” OR “Liver Transplantation” AND “Ischemic preconditioning” OR “occlusion” OR “clamping” OR “Pringle.” The following outcome data were retrieved: the rates of graft primary nonfunction (PNF), retransplantation, graft loss, and mortality; stay in hospital and the intensive care unit; and postoperative serum liver damage parameters. Results: The initial search retrieved 4,522 potentially relevant studies. After evaluating 17 full-text articles, a total of 9 randomized controlled trials (RCTs) were included (7 IPC and 2 RIPC studies) in the qualitative synthesis; the meta-analysis was only performed on the data from the IPC studies. RIPC studies had considerable methodological differences. The meta-analysis revealed the beneficial effect of IPC when comparing postoperative aspartate aminotransferase (AST) corresponding to a statistically lower mortality rate in the IPC group (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.27–0.98; p = 0.04). Conclusion: IPC lowers postoperative AST levels and reduces the mortality rate; however, data on the benefits of RIPC are lacking.
Visc Med

中文翻译：

---

肝移植的缺血预处理：随机对照试验的系统评价和荟萃分析

背景：近几十年来，肝移植（LTx）提高了终末期器官衰竭患者的生存率和生活质量。不幸的是，由于捐助者短缺，LTx 受到了限制。大量努力寻找新的方法来减少肝移植物中的缺血再灌注损伤 (IRI)，以增加从扩展标准供体 (ECD) 获得的合适器官的数量。本研究的目的是系统回顾文献报道使用缺血预处理 (IPC) 或远程缺血预处理 (RIPC) 降低肝移植物 IRI 时的 LTx 结果。方法：在 MEDLINE、Web of Science 和 EMBASE 数据库中进行了文献检索。使用了以下组合：“肝脏”或“肝脏移植”和“缺血预处理”或“闭塞”或“钳夹”或“Pringle”。检索了以下结果数据：移植物原发性无功能（PNF）、再移植、移植物丢失和死亡率；留在医院和重症监护室；及术后血清肝损伤参数。结果：最初的搜索检索到 4,522 项可能相关的研究。在评估了 17 篇全文文章后，共纳入 9 项随机对照试验（RCT）（7 项 IPC 和 2 项 RIPC 研究）进行定性综合；荟萃分析仅对来自 IPC 研究的数据进行。RIPC 研究有相当大的方法学差异。荟萃分析显示，在比较术后天冬氨酸氨基转移酶 (AST) 时 IPC 的有益作用对应于 IPC 组统计学上较低的死亡率（优势比 [OR] 0.51；95% 置信区间 [CI] 0.27-0.98；p = 0.04)。结论： IPC降低术后AST水平，降低病死率；然而，缺乏关于 RIPC 益处的数据。
粘性医学