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October 20, 2008

Preconditioning or Postconditioning in Hepatic Surgery—Reply

Arch Surg. 2008;143(10):1026. doi:10.1001/archsurg.143.10.1026-b

In reply

I would like to thank Drs Sadat and Varty for their comments. As they pointed out, ischemic preconditioning was proposed in 1986 by Murry and colleagues1 to reduce ischemia-reperfusion injury. However, it has only been applied to liver surgery in the last decade after the experimental and human studies reported by Selzner et al2 and Clavien et al.3 The hypothesis of a beneficial effect is that ischemic preconditioning can reduce the apoptosis in the hepatic cells and induce development of natural defense mechanisms.3 In the most recent review, Clavien et al3 reported that ischemic preconditioning and intermittent clamping are equally effective in minimizing postoperative liver injury and that intermittent clamping is even superior when total ischemia is longer than 75 minutes.3