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Oxidative Medicine and Cellular Longevity
Volume 2016, Article ID 8235921, 21 pages
Review Article

Beyond Preconditioning: Postconditioning as an Alternative Technique in the Prevention of Liver Ischemia-Reperfusion Injury

1Department of Anesthesiology, Aretaieion University Hospital, University of Athens Medical School, 11528 Athens, Greece
2Department of Anaesthetics, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK
3Second Department of Surgery, Aretaieion University Hospital, University of Athens Medical School, 11528 Athens, Greece
4Fourth Department of Surgery, Attikon University Hospital, University of Athens Medical School, 12462 Athens, Greece

Received 30 December 2015; Revised 11 April 2016; Accepted 5 May 2016

Academic Editor: Ersin Fadillioglu

Copyright © 2016 Kassiani Theodoraki 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.


Liver ischemia/reperfusion injury may significantly compromise hepatic postoperative function. Various hepatoprotective methods have been improvised, aiming at attenuating IR injury. With ischemic preconditioning (IPC), the liver is conditioned with a brief ischemic period followed by reperfusion, prior to sustained ischemia. Ischemic postconditioning (IPostC), consisting of intermittent sequential interruptions of blood flow in the early phase of reperfusion, seems to be a more feasible alternative than IPC, since the onset of reperfusion is more predictable. Regarding the potential mechanisms involved, it has been postulated that the slow intermittent oxygenation through controlled reperfusion decreases the burst production of oxygen free radicals, increases antioxidant activity, suppresses neutrophil accumulation, and modulates the apoptotic cascade. Additionally, favorable effects on mitochondrial ultrastructure and function, and upregulation of the cytoprotective properties of nitric oxide, leading to preservation of sinusoidal structure and maintenance of blood flow through the hepatic circulation could also underlie the protection afforded by postconditioning. Clinical studies are required to show whether biochemical and histological improvements afforded by the reperfusion/reocclusion cycles of postconditioning during early reperfusion can be translated to a substantial clinical benefit in liver resection and transplantation settings or to highlight more aspects of its molecular mechanisms.