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Effect of intravenous methylprednisolone on the degree of hepatic ischemia/reperfusion injury in class III hypovolemic shock conditions performed continuous clamping in rats

  • Suryo Wahyu Raharjo ,
  • Tomy Lesmana ,

Abstract

Link of Video Abstract: https://youtu.be/9qgtSz73eyE

 

Introduction: Pringle maneuver is the choice of hepatic inflow occlusion, when blood circulation is reopened, reperfusion will occur which causes ischemia/reperfusion injury (IRI) which will result in liver tissue damage. Methylprednisolone injection plays a role in deactivating kupffer thereby preventing inflammatory reactions that will reduce hepatic IRI. This study aims to determine intravenous methylprednisolone's effect on the degree of hepatic ischemia/reperfusion injury in class III hypovolemic shock where continuous clamping was performed.

Methods: Fifteen white rats (Rattus novergicus) underwent laparotomy, aspiration of blood up to 30% of the estimated blood volume (EBV) was carried out to prevent class III hypovolemic shock. The treatment group was given a single dose of 30 mg/kgBW methylprednisolone, while the control group received 30 mg/KgBW 0.9% sodium chloride. Then the Pringle maneuver continuous clamping is performed for up to 30 minutes and resuscitation of the aspirated blood back to the vena cava. On the 5th postoperative day, hepatic biopsy and total bilirubin were examined.

Results: Histopathological examination of the liver parenchyma as assessed by Suzuki's score showed a mean ± SD of the control group (K) 1.40 ± 0.91 while the treatment group (MP) 5.93 ± 1.03 with a p-value of 0.001 < 0.05. Total bilirubin results showed a mean ± SD of the control group (K) 0.21 ±  0.13 while the treatment group (MP) 0.22 ±  0.11 with a p-value of 0.477 > 0.05.

Conclusion: Intravenous methylprednisolone in rats that experienced ischemic/reperfusion injury after continuous clamping in class III hypovolemic shock did not reduce the degree of hepatic parenchymal damage assessed by Suzuki's histopathology score. However, it reduces the total bilirubin value. 

References

  1. Huntington JT, Royall NA, Schmidt CR. Minimizing blood loss during hepatectomy: a literature review. J Surg Oncol. 2014;109(2):81-8. Available from: doi: 10.1002/jso.23455.
  2. Jaeschke H, Woolbright BL. Current strategies to minimize hepatic ischemia-reperfusion injury by targeting reactive oxygen species. Transplant Rev (Orlando). 2012;26(2):103–14. Available from: https://pubmed.ncbi.nlm.nih.gov/22459037
  3. Ildefonso JÁ, Arias-Díaz J. Pathophysiology of liver ischemia—Reperfusion injury. Cirugía Española (English Ed. 2010;87(4):202–9. Available from: http://dx.doi.org/10.1016/s2173-5077(10)70049-1
  4. Yamanaka K, Houben P, Bruns H, Schultze D, Hatano E, Schemmer P. A systematic review of pharmacological treatment options used to reduce ischemia reperfusion injury in rat liver transplantation. PLoS One. 2015;10(4):e0122214–e0122214. Available from: https://pubmed.ncbi.nlm.nih.gov/25919110
  5. Toledo-Pereyra Lh, Rodriguez Fj, Cejalvo D. Neutrophil Infiltration As An Important Factor In Liver Ischemia And Reperfusion Injury. Transplantation. 1993;55(6):1265–71. Available from: http://dx.doi.org/10.1097/00007890-199306000-00011
  6. Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, et al. The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242(6):824–9. Available from: https://pubmed.ncbi.nlm.nih.gov/16327492
  7. Nasronudin NP. Colloid and Methylprednisolone Therapy as Alternative Management of Dhf. Bul Penelit Sist Kesehat. 2010;13(3)1-7.
  8. Ayala A, Chung CS, Lomas JL, Song GY, Doughty LA, Gregory SH, Cioffi WG, LeBlanc BW, Reichner J, Simms HH, Grutkoski PS. Shock-induced neutrophil mediated priming for acute lung injury in mice: divergent effects of TLR-4 and TLR-4/FasL deficiency. Am J Pathol. 2002;161(6):2283-94. Available from: doi: 10.1016/S0002-9440(10)64504-X.
  9. Hasegawa Y, Nitta H, Takahara T, Katagiri H, Kanno S, Umemura A, et al. Glucocorticoid use and ischemia-reperfusion injury in laparoscopic liver resection: Randomized controlled trial. Ann Gastroenterol Surg. 2019;4(1):76–83. Available from: https://pubmed.ncbi.nlm.nih.gov/32021961
  10. Stephens C, Castiella A, Gomez-Moreno EM, Otazua P, López-Nevot M-Á, Zapata E, et al. Autoantibody presentation in drug-induced liver injury and idiopathic autoimmune hepatitis. Pharmacogenet Genomics. 2016;26(9):414–22. Available from: http://dx.doi.org/10.1097/fpc.0000000000000230
  11. Zoubek ME, Pinazo-Bandera J, Ortega-Alonso A, Hernández N, Crespo J, Contreras F, et al. Liver injury after methylprednisolone pulses: A disputable cause of hepatotoxicity. A case series and literature review. United Eur Gastroenterol J. 2019/03/24. 2019;7(6):825–37. Available from: https://pubmed.ncbi.nlm.nih.gov/31316787
  12. Loraschi A, Banfi P, Mauri M, Sessa F, Bono G, Cosentino M. Hepatotoxicity After High-Dose Methylprednisolone for Demyelinating Disease. Clin Neuropharmacol. 2010;33(1):52–4. Available from: http://dx.doi.org/10.1097/wnf.0b013e3181bbf3a7
  13. Takahashi A, Kanno Y, Takahashi Y, Sakamoto N, Monoe K, Saito H, et al. Development of autoimmune hepatitis type 1 after pulsed methylprednisolone therapy for multiple sclerosis: a case report. World J Gastroenterol. 2008;14(35):5474–7. Available from: https://pubmed.ncbi.nlm.nih.gov/18803363
  14. Sari GM. The Effect Of Long Term Administration Of Glucocorticoid To Bone Lining Cells Apoptosis. Folia Medica Indones. 2017;52(4):251. Available from: http://dx.doi.org/10.20473/fmi.v52i4.5471
  15. Stravitz RT, Sanyal AJ. Drug-induced steatohepatitis. Clin Liver Dis. 2003;7(2):435–51. Available from: http://dx.doi.org/10.1016/s1089-3261(03)00027-8
  16. Dourakis SP, Sevastianos VA, Kaliopi P. Acute severe steatohepatitis related to prednisolone therapy. Am J Gastroenterol. 2002;97(4):1074–5. Available from: http://dx.doi.org/10.1111/j.1572-0241.2002.05644.x
  17. Gunawan BK, Kaplowitz N. Mechanisms of Drug-Induced Liver Disease. Clin Liver Dis. 2007;11(3):459–75. Available from: http://dx.doi.org/10.1016/j.cld.2007.06.001
  18. Zimmermann H, Reichen J. Hepatectomy: Preoperative Analysis of Hepatic Function and Postoperative Liver Failure. Dig Surg. 1998;15(1):1–11. Available from: http://dx.doi.org/10.1159/000018578
  19. Suc B, Panis Y, Belghiti J, Fékété F. ‘Natural history’ of hepatectomy. Br J Surg. 1992;79(1):39–42. Available from: http://dx.doi.org/10.1002/bjs.1800790113
  20. Bader KF. Thoracic Ileopexy for Portal Hypertension. Arch Surg. 1964;89(1):228. Available from: http://dx.doi.org/10.1001/archsurg.1964.01320010230027
  21. Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child–Pugh versus MELD. J Hepatol. 2005;42(1):S100–7. Available from: http://dx.doi.org/10.1016/j.jhep.2004.11.015
  22. Fan S-T, Lo C-M, Lai E, Chu K-M, Liu C-L, Wong J. Perioperative Nutritional Support in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. N Engl J Med. 1994;331(23):1547–52. Available from: http://dx.doi.org/10.1056/nejm199412083312303
  23. Budipramana VS. Lactate Level as a Prediction Factor of Reperforation after Repairing Gastric Perforation. Folia Medica Indones. 2019;55(1):43. Available from: http://dx.doi.org/10.20473/fmi.v55i1.12556
  24. Imamura H. One Thousand Fifty-Six Hepatectomies Without Mortality in 8 Years. Arch Surg. 2003;138(11):1198. Available from: http://dx.doi.org/10.1001/archsurg.138.11.1198
  25. Cohnert TU, Rau HG, Buttler M.D. E, Hernandez-Richter T, Sauter G, Reuter C, et al. Preoperative Risk Assessment of Hepatic Resection for Malignant Disease. World J Surg. 1997;21(4):396–401. Available from: http://dx.doi.org/10.1007/pl00012260

How to Cite

Raharjo, S. W., & Lesmana, T. (2023). Effect of intravenous methylprednisolone on the degree of hepatic ischemia/reperfusion injury in class III hypovolemic shock conditions performed continuous clamping in rats. Bali Medical Journal, 12(2), 1805–1812. https://doi.org/10.15562/bmj.v12i2.4488

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