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ABSTRACT
The present review discusses strategies for minimizing the ischemia/reperfusion injury (IRI) experienced during liver surgery and transplantation. We present the experimental models used to study the complexity of hepatic IRI and new surgical and pharmacologic strategies for manipulating and improving liver function after liver surgery and transplantation. This would be of clinical interest to reduce the prevalence of IRI and improve patient management and outcomes. The ongoing effort to expand the pool of usable liver grafts has made it clear that a better understanding of the mechanisms of IRI and other consequences of using expanded criteria donor (ECD) liver allografts are critical to improving results with these grafts.
| NOMENCLATURE | ||
| ACE | = | Angiotensin-converting enzyme |
| Anti-LPS | = | Anti-lipopolysaccharide |
| ATP | = | Adenosine triphosphate |
| AT1R | = | Angiotensin 1 receptors |
| AT2R | = | Angiotensin 2 receptors |
| CC | = | Continuous clamping |
| CDC | = | Centers for Disease Control |
| CPB | = | Cardiopulmonary bypass |
| CS1 | = | Connecting segment-1 |
| DCD | = | Donation after cardiac death |
| ECD | = | Expanded criteria donors |
| ECMO | = | Extracorporeal membrane oxygenation |
| EGF | = | Epidermal growth factor |
| ER | = | Endoplasmic reticulum |
| GdCl3 | = | Gadolinium chloride |
| GSK3β | = | Glycogen synthase kinase-3β |
| HGF | = | Hepatocyte growth factor |
| HMP | = | Hypothermic machine perfusion |
| HTK | = | Histidine–tryptophan–ketoglutarate |
| HTK-N | = | HTK solution that containsN-acetylhistidine |
| IC | = | Intermittent clamping |
| IGF-I | = | Insulin growth actor |
| IL-6 | = | Interleukin-6 |
| IP | = | Ischemic preconditioning |
| I/R | = | Ischemic reperfusion |
| IRI | = | Ischemic reperfusion injury |
| LDLT | = | Living donor liver transplantation |
| LT | = | Liver transplantation |
| MAC | = | Membrane attack complex |
| MP | = | Methyl prednisolone |
| MSCs | = | Mesenchymal stem cells |
| NMP | = | Normothermic machine perfusion |
| NO | = | Nitric oxide |
| NR | = | Normothermic recirculation |
| PNF | = | Primary nonfunction |
| RAS | = | Renin–angiotensin system |
| ROS | = | Reactive oxygen species |
| SCS | = | Static cold storage |
| SLT | = | Split liver transplantation |
| TNF-α | = | Tumor necrosis factor-α |
| UCP2 | = | Uncoupling protein 2 |
| UW | = | University of Wisconsin |
| VEGF | = | Vascular endothelial growth factor |
| XDH/XOD | = | Xanthine/xanthine oxidase |