Impact of Ischemic Preconditioning on Outcome in Clinical Liver Surgery: A Systematic Review

Table 1

Summary of outcome in nonrandomized clinical studies of ischemic preconditioning in orthotopic liver transplantation.

Author	Year	Study type	Donor type	IPC	No IPC	Duration of IPC (mins)	Mean ischemic time (mins)	Outcome measures	Effect of IPC
Jassem et al. [29]	2006	Case control	DBD	9	14	10 + up to 30	690	Blood tests,; AR, AST, ICU, INR, IOBL, PNF	↓AR (NS), ↓AST, ↓ICU,; ↑IOBL (NS)
Cescon et al. [32]	2009	Prospective^1	DBD	20	20	10 + 15	360	Bili, ICU, GS, IPF, INR, LFT, PNF, PS, transfusion	No difference
Esposti et al. [30]	2011	Retrospective	DBD	26	24	10 + 10	440	AR, Bili, CR, Histo, HS, ICU, LFT, morbidity, transfusion	↓ALT/AST^2
Azoulay et al. [31]	2005	Prospective^3	DBD	46	45	10 + 10	448	AR, Bili, Histo, HS, ICU, IPF, LFT, morbidity, PNF, PS, PT, transfusion	↓ALT/AST, ↑HS/ICU (NS), ↓necrosis, ↑IPF
Andreani et al. [33]	2010	Prospective	LRLT	22	22	10 + 10	155	AR, Bili, GS, Histo, HS, ICU, LFT, morbidity, PNF, PS, PT, transfusion	No difference
Testa et al. [34]	2010	Prospective	LRLT	10	10	10 + 10	120	AR, Bili, GS, HS, INR, LFT, morbidity, PS, transfusion	No difference

ALT, alanine aminotransferase; AR, acute rejection; AST, aspartate aminotransferase; Bili, bilirubin; CR, chronic rejection; DBD, donation after brain death; GS, graft survival; Histo, histology; HS, hospital stay; ICU, intensive care unit stay; INR, international normalized ratio; IOBL, intraoperative blood loss; IPC, ischemic preconditioning; IPF, initial poor function; LFT, liver function tests; LRLT, living-related liver transplantation; NS, no statistically significant difference according to the author; PNF, primary nonfunction; PS, patient survival; PT, prothrombin time.
¹IPF not defined.
²In nonsteatotic allografts only.
³IPF defined as minimal PT <30% normal level and/or maximum bilirubin >200 mol/L in absence of hemolysis or biliary obstruction.