The Effect of Remote Ischemic Preconditioning in Living Donor Hepatectomy

Not Applicable

Completed

• Conditions: Liver Transplantation; Ischemia Reperfusion Injury; Tissue Donors
• Interventions: Procedure: remote ischemic preconditioning

• Registration Number: NCT03386435
• Lead Sponsor: Asan Medical Center

Brief Summary

Liver transplantation is the gold standard treatment for patients with end-stage liver disease. Despite its outstanding success, liver transplantation still entails certain complications including ischemia-reperfusion injury. Remote ischemic preconditioning is a novel and simple therapeutic method to lessen the harmful effects of ischemia-reperfusion injury, however, the majority of remote ischemic preconditioning studies on hepatic ischemia-reperfusion injury have been animal studies. Therefore, our aim was to assess the effects of remote ischemic preconditioning on postoperative liver function in living donor hepatectomy.

Detailed Description

Liver transplantation(LT) is the gold standard treatment for patients with end-stage liver disease. In light of advancements in surgical techniques, immunosuppressive agents, and perioperative critical care, the overall 3-year survival of patients undergoing LT has exceeded 80%. Despite its outstanding success, LT still entails certain complications including ischemia-reperfusion injury (IRI).

IRI occurs when the blood supply to an organ or tissue is temporarily cut-off and then restored, and it is well-known as an underlying cause of primary non-function, biliary complications, and eventual graft loss after LT. Despite many attempts to ameliorate hepatic IRI, no definitive therapies have been established. In addition, the mechanisms of IRI remain largely unclear.

Remote ischemic preconditioning (RIPC) is a novel and simple therapeutic method to lessen the harmful effects of IRI. RIPC indicate that brief episodes of ischemia with intermittent reperfusion are introduced at a remote site, leading to systemic protection against subsequent insults as evinced on kidney, heart, liver, and other tissues. While RIPC has been shown to reduce hepatic IRI in several small animal studies, the beneficial effects of RIPC in hepatic IRI have been inconsistent. By far, the majority of RIPC studies on hepatic IRI have been animal studies; hence, there are limitations relating to the lack of human clinical trials.

Therefore, our aim was to assess the effects of RIPC on postoperative liver function in living donor hepatectomy.

Study Timeline

• Study Start: 2016-08-22
• Primary Completion: 2017-08-31
• Study Completion: 2017-10-30
• Study First Submitted: 2017-12-15
• Study First Submitted QC: 2017-12-21
• Study First Posted: 2017-12-29
• Results First Submitted: 2019-03-05
• Status Verified: 2019-08
• Results First Submitted QC: 2019-08-10
• Last Update Submitted: 2019-08-10
• Results First Posted: 2019-08-19
• Last Update Posted: 2019-08-19

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 160

Inclusion Criteria

• Donors who plan to have living right hepatectomy for liver transplantation.
• age : between 18 to 60 years.

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Exclusion Criteria

• donors who plan to donate left lobe
• donors who plan to have laparoscopic right hepatectomy
• donors who cannot proceed remote ischemic preconditioning

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
RIPC	remote ischemic preconditioning	intervention: RIPC groups receive remote ischaemic preconditioning after anaesthesia induction and before surgery started.

Primary Outcome Measures

Name	Time	Method
Postopera The Maximal Aspartate Aminotransferase Level Within 7 Postoperative Days	within 7 days after operation	The serial assessments of routine laboratory values were used as early markers for postoperative liver function. The maximal aspartate aminotransferase level within 7 postoperative days were assessed following RIPC in living donor hepatectomy.
The Maximal Alanine Aminotransferase Level Within 7 Postoperative Days	within 7 days after operation	The serial assessments of routine laboratory values were used as early markers for postoperative liver function. The maximal alanine aminotransferase level within 7 postoperative days were assessed following RIPC in living donor hepatectomy

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Delayed Recovery of Liver Function	postoperative 7 days	The incidence of delayed recovery of hepatic function (DRHF) were used as surrogate parameters indicating the possible benefits of RIPC. DRHF was defined based on a proposal by the International Study Group of Liver Surgery, as follows: an impaired ability of the liver to maintain its synthetic, excretory, and detoxifying functions, which are characterized by an increased PT INR and concomitant hyperbilirubinemia (considering the normal limits of the local laboratory) on or after postoperative day 5. The normal upper limits of PT and bilirubin in our institutional laboratory were 1.30 INR and 1.2 mg/dL, respectively. If either the PT INR or serum bilirubin concentration was preoperatively elevated, DRHF was defined by an increasing PT INR and increasing serum bilirubin concentration on or after postoperative day 5 (compared with the values of the previous day).
Postoperative Liver Regeneration	1 month	The postoperative liver regeneration index (LRI) at postoperative 1 month ) was used as surrogate parameters indicating the possible benefits of RIPC. The LRI was defined as \[(VLR - VFLR)/VFLR)\] × 100, where VLR is the volume of the liver remnant and VFLR is the volume of the future liver remnant. Liver volume was calculated by CT volumetry using 3-mm-thick dynamic CT images. The graft weight was subtracted from the total liver volume to define the future liver remnant.

Trial Locations

Locations (1)

Asan medical center; 🇰🇷 Seoul, Songpa-gu, Korea, Republic of