THERAPEUTIC MODULATION OF FREE RADICAL-MEDIATED REPERFUSION INJURY OFTHE LIVER AND ITS SURGICAL IMPLICATIONS

It is well known that ischemia causes functional and structural damage to liver cells, and that the status of energy metabolism provides an important means of assessing the functional viability of the ischemic organ, However, the specific sequence leading to ischemic liver cell i njury is not yet fully understood; therefore, it is clinically and pat hophysiologically important to elucidate the mechanism of cellular inj ury during hepatic ischemia and subsequent reperfusion, Whereas the co nventional view attributes this injury process to the ischemia itself, recent studies have demonstrated that a variable but often substantia l proportion of this injury is caused by reactive oxygen metabolites t hat are generated at the time of reperfusion. This article presents an outline of the mechanism of cellular injury caused during hepatic isc hemia and subsequent reperfusion resulting from certain types of surge ry, with special reference to the xanthine-xanthine oxidase system and the activation of neutrophils and macrophages.