Effects of preoperative statin on liver reperfusion injury in major hepatic resection: a pilot study.

Abstract

During major liver resection, ischemia reperfusion injury occurs resulting in adverse outcome. Animal studies have demonstrated the beneficial effect of statins on hepatic ischemic injury, but no clinical studies have been performed. Twenty consecutive patients undergoing major hepatic resection were included and were randomized into two groups. The study group (n=10) patients received oral atorvastatin 40mg for 3days prior to surgery, including the day of surgery, and the control group (n=10) received a placebo. Outcomes were assessed at 4, 24, and 72h by measurement of serum liver enzymes and cytokines-IL-1, IL-6, CRP, and TNF α. The two groups were evenly matched for demographic and perioperative variables. The AST levels were significantly higher in the control group compared with the study group at 4h (909.60±222 vs. 362.6±129 U/L), 24h (215.30±86.9 vs. 605.30±186.1 U/L) and 72h (84.30±32.7 vs. 204.70±67.5) (p<0.001). Plasma IL-1 values in the study group showed significantly lower values compared with the control group (p<0.001) postoperatively. Plasma IL-6 values postoperatively showed significantly lower mean values as compared with the mean of the control population (p<0.001). TNF α values at 4, 24, and 72h postoperatively comparable in the two groups (p=0.011) (p=0.096) and (p=0.237), respectively. Statins have the potential for pharmacological prevention of IRI. Further studies would be needed to substantiate the role of statins in prevention of IRI during liver resection. PGIMER, Chandigarh-NK/1081/MS/12182-83.