Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
J Hepatol. 2013 Nov;59(5):1094-106. doi: 10.1016/j.jhep.2013.06.017. Epub 2013 Jun 25.
Ischemia-reperfusion injury is an important cause of liver damage occurring during surgical procedures including hepatic resection and liver transplantation, and represents the main underlying cause of graft dysfunction post-transplantation. Cellular and biochemical processes occurring during hepatic ischemia-reperfusion are diverse and complex, and include the deregulation of the healthy phenotype of all liver cellular components. Nevertheless, a significant part of these processes are still unknown or unclear. The present review aims at summarizing the current knowledge in liver ischemia-reperfusion, but specifically focusing on liver cell phenotype and paracrine interaction deregulations. Moreover, the most updated therapeutic strategies including pharmacological, genetic and surgical interventions, as well as some of the scientific controversies in the field will be described. Finally, the importance of considering the subclinical situation of liver grafts when translating basic knowledge to the bedside is discussed.
缺血再灌注损伤是肝切除和肝移植等外科手术过程中肝损伤的一个重要原因,也是移植后移植物功能障碍的主要潜在原因。肝缺血再灌注过程中发生的细胞和生化过程是多样和复杂的,包括所有肝细胞成分的正常表型失调。然而,这些过程的很大一部分仍然未知或不清楚。本综述旨在总结目前对肝缺血再灌注的认识,但特别侧重于肝细胞表型和旁分泌相互作用的失调。此外,还将描述包括药理学、遗传学和外科干预在内的最新治疗策略,以及该领域的一些科学争议。最后,讨论了在将基础知识转化为临床实践时考虑肝移植物亚临床情况的重要性。