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HPB Surgery
Volume 2012 (2012), Article ID 783479, 8 pages
Research Article

Effects of a Preconditioning Oral Nutritional Supplement on Pig Livers after Warm Ischemia

1Department of General and Transplant Surgery, Ruprecht-Karls University, 69120 Heidelberg, Germany
2Institute of Pathology, Ruprecht-Karls University, 69120 Heidelberg, Germany
3Central Laboratory, Ruprecht-Karls University, 69120 Heidelberg, Germany
4Fresenius Kabi Deutschland GmbH, 61440 Oberursel, Germany
5HealthEcon AG, 4051 Basel, Switzerland

Received 25 February 2012; Accepted 3 May 2012

Academic Editor: John J. Lemasters

Copyright © 2012 Arash Nickkholgh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Several approaches have been proposed to pharmacologically ameliorate hepatic ischemia/reperfusion injury (IRI). This study was designed to evaluate the effects of a preconditioning oral nutritional supplement (pONS) containing glutamine, antioxidants, and green tea extract on hepatic warm IRI in pigs. Methods. pONS (70 g per serving, Fresenius Kabi, Germany) was dissolved in 250 mL tap water and given to pigs 24, 12, and 2 hrs before warm ischemia of the liver. A fourth dose was given 3 hrs after reperfusion. Controls were given the same amount of cellulose with the same volume of water. Two hours after the third dose of pONS, both the portal vein and the hepatic artery were clamped for 40 min. 0.5, 3, 6, and 8 hrs after reperfusion, heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), portal venous flow (PVF), hepatic arterial flow (HAF), bile flow, and transaminases were measured. Liver tissue was taken 8 hrs after reperfusion for histology and immunohistochemistry. Results. HR, MAP, CVP, HAF, and PVF were comparable between the two groups. pONS significantly increased bile flow 8 hrs after reperfusion. ALT and AST were significantly lower after pONS. Histology showed significantly more severe necrosis and neutrophil infiltration in controls. pONS significantly decreased the index of immunohistochemical expression for TNF-α, MPO, and cleaved caspase-3 ( 𝑃 < 0 . 0 0 1 ). Conclusion. Administration of pONS before and after tissue damage protects the liver from warm IRI via mechanisms including decreasing oxidative stress, lipid peroxidation, apoptosis, and necrosis.