Effects of Remote Ischemic Conditioning on Postoperative Recovery After Hepatectomy: A Randomised Controlled Trial

IF 6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-02-21 DOI:10.1111/liv.70041

Chun Tian, Hongni Tian, Wenlang Li, Jie Chen, Qiao Guo, Guangyou Duan, He Huang

{"title":"Effects of Remote Ischemic Conditioning on Postoperative Recovery After Hepatectomy: A Randomised Controlled Trial","authors":"Chun Tian, Hongni Tian, Wenlang Li, Jie Chen, Qiao Guo, Guangyou Duan, He Huang","doi":"10.1111/liv.70041","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Aims</h3>\n \n <p>Remote ischemic conditioning (RIC) has shown promise in preclinical and clinical studies, but its effectiveness in reducing hepatic ischemia–reperfusion injuries (HIRIs) and enhancing postoperative recovery after hepatectomy remains uncertain. In this study, we aimed to evaluate the impact of perioperative RIC (PRIC) on postoperative recovery in patients undergoing hepatectomy.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A randomised controlled trial was performed. A total of 135 eligible patients were randomised to either a control group (sham RIC), a PRIC-1 group (RIC once daily for 3 days starting on the day of surgery) or a PRIC-2 group (RIC twice daily). The primary outcome was the time to 2 times the upper limit of normal (2ULN) alanine transaminase (ALT) levels post-hepatectomy. Secondary outcomes included time to reach 2ULN for aspartate transaminase (AST) levels, the area under the concentration–time curve on postoperative Day 7 (AUC-POD7) for ALT, AST, total bilirubin and lactic acid, as well as assessments of gastrointestinal function and postoperative complications.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Median time to 2ULN ALT was shorter in the PRIC-1 and PRIC-2 groups than in the control group (PRIC-1: 5.0 [3.5, 6.0] vs. control: 7.0 [7.0, 10.0] days, <i>p</i> < 0.001; PRIC-2: 5.0 [4.0, 8.0] vs. control: 7.0 [7.0, 10.0] days, <i>p</i> < 0.001). The AUC-POD7 for ALT and AST, time to 2ULN AST, time to gastrointestinal tolerance and postoperative complications were significantly improved in the PRIC groups compared with thecontrols.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>PRIC is safe and effective in reducing HIRIs and enhancing recovery post-hepatectomy. Once-daily PRIC offers similar benefits to twice-daily PRIC.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>NCT06130436 (ClinicalTrials.gov)</p>\n </section>\n </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 3","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Liver International","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/liv.70041","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Aims

Remote ischemic conditioning (RIC) has shown promise in preclinical and clinical studies, but its effectiveness in reducing hepatic ischemia–reperfusion injuries (HIRIs) and enhancing postoperative recovery after hepatectomy remains uncertain. In this study, we aimed to evaluate the impact of perioperative RIC (PRIC) on postoperative recovery in patients undergoing hepatectomy.

Methods

A randomised controlled trial was performed. A total of 135 eligible patients were randomised to either a control group (sham RIC), a PRIC-1 group (RIC once daily for 3 days starting on the day of surgery) or a PRIC-2 group (RIC twice daily). The primary outcome was the time to 2 times the upper limit of normal (2ULN) alanine transaminase (ALT) levels post-hepatectomy. Secondary outcomes included time to reach 2ULN for aspartate transaminase (AST) levels, the area under the concentration–time curve on postoperative Day 7 (AUC-POD7) for ALT, AST, total bilirubin and lactic acid, as well as assessments of gastrointestinal function and postoperative complications.

Results

Median time to 2ULN ALT was shorter in the PRIC-1 and PRIC-2 groups than in the control group (PRIC-1: 5.0 [3.5, 6.0] vs. control: 7.0 [7.0, 10.0] days, p < 0.001; PRIC-2: 5.0 [4.0, 8.0] vs. control: 7.0 [7.0, 10.0] days, p < 0.001). The AUC-POD7 for ALT and AST, time to 2ULN AST, time to gastrointestinal tolerance and postoperative complications were significantly improved in the PRIC groups compared with thecontrols.

Conclusions

PRIC is safe and effective in reducing HIRIs and enhancing recovery post-hepatectomy. Once-daily PRIC offers similar benefits to twice-daily PRIC.

Trial Registration

NCT06130436 (ClinicalTrials.gov)

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.