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Acta Cir Bras. 2018 Aug;33(8):723-735. doi: 10.1590/s0102-865020180080000008.

Liver ischemia and reperfusion injury. Pathophysiology and new horizons in preconditioning and therapy.

Author information

1
Medical student, Surgery and Anatomy Department, Medical School, Universidade de São Paulo (USP), Ribeirao Preto-SP, Brazil. Scientific and intellectual content of the study; acquisition, analysis and interpretation of data.
2
BScN, USP, College of Nursing, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirao Preto-SP, Brazil. Scientific and intellectual content of the study, manuscript preparation.
3
Laboratory Specialist, Surgery and Anatomy Department, Medical School, USP, Ribeirao Preto-SP, Brazil. Scientific and intellectual content of the study.
4
PhD, General and Specialized Nursing Department, USP, College of Nursing, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirao Preto-SP, Brazil. Scientific and intellectual content of the study.
5
Full Professor, Surgery and Anatomy Department, Medical School, USP, Ribeirao Preto-SP, Brazil. Scientific and intellectual content of the study.
6
Full Professor, Department of Gastroenterology, Medical School, USP, Ribeirao Preto-SP, Brazil. Scientific and intellectual content of the study.
7
Full Professor, Surgery and Anatomy Department, and Department of Gastroenterology, Medical School, USP, Ribeirao Preto-SP, Brazil. Scientific, intellectual, conception and design of the study; acquisition, analysis and interpretation of data; manuscript writing; critical revision; final approval.

Abstract

It is well known that during hepatic operative procedures, it is often critical that the irrigation is interrupted to avoid possible bleeding, blood transfusions, variable intensities, and their short and long-term consequences. It was believed in the past that the flow interruption should not exceed 20 minutes, which limited the use of this maneuver. However, it has been postulated that ischemia could be maintained for more than 60 minutes in healthy livers. The present paper review includes: 1) A brief introduction to justify the rationale of the review design; 2) Aspects of the pathophysiology of the three stages of the liver ischemia-reperfusion injury; 3) The innate and acquired immunity; 4) Oxidative stress; 5) Apoptosis and autophagy, Some essential biomarkers (Tumor Necrosis Factor-α, nitric oxide, metalloproteinases); and, finally; 6) Preventive ("cheating") strategies, non-pharmacological and pharmacological options to treat the liver IR injury.

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