Timing-dependent protection of hypertonic saline solution administration in experimental liver ischemia/reperfusion injury
Accepted 5 October 2009. published online 11 December 2009.
Background
During liver ischemia, the decrease in mitochondrial energy causes cellular damage that is aggravated after reperfusion. This injury can trigger a systemic inflammatory syndrome, also producing remote organ damage. Several substances have been employed to decrease this inflammatory response during liver transplantation, liver resections, and hypovolemic shock. The aim of this study was to evaluate the effects of hypertonic saline solution and the best timing of administration to prevent organ injury during experimental liver ischemia/reperfusion.
Methods
Rats underwent 1 hr of warm liver ischemia followed by reperfusion. Eighty-four rats were allocated into 6 groups: sham group, control of ischemia group (C), pre-ischemia treated NaCl 0.9% (ISS) and NaCl 7.5% (HTS) groups, pre-reperfusion ISS, and HTS groups. Blood and tissue samples were collected 4 hr after reperfusion.
Results
HTS showed beneficial effects in prevention of liver ischemia/reperfusion injury. HTS groups developed increases in AST and ALT levels that were significantly less than ISS groups; however, the HTS pre-reperfusion group showed levels significantly less than the HTS pre-ischemia group. No differences in IL-6 and IL-10 levels were observed. A significant decrease in mitochondrial dysfunction as well as hepatic edema was observed in the HTS pre-reperfusion group. Pulmonary vascular permeability was significantly less in the pre-reperfusion HTS group compared to the ISS group. No differences in myeloperoxidase activity were observed. The liver histologic score was significantly less in the pre-reperfusion HTS group compared to the pre-ischemia HTS group.
Conclusion
HTS ameliorated local and systemic injuries in experimental liver ischemia/reperfusion. Infusion of HTS in the pre-reperfusion period may be an important adjunct to accomplish the best results.
Liver Transplantation Service, Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
Reprint requests: Estela Regina Ramos Figueira, MD, Liver Transplantation Service, Department of Surgery, University of São Paulo Medical School, Rua dos Ingleses 586, apto 194. CEP: 01329-000, São Paulo, S.P., Brazil.
This work was supported by grant 05/04226-7 from Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).
ABSTRACT