Protective effect of prostaglandin E1 against ischemia/reperfusion-inducedliver injury: results of a prospective, randomized study in cirrhotic patients undergoing subsegmentectomy

Background/Aims: The cytoprotective effects of prostaglandin El on livers s uffering from ischemia/ reperfusion injury in the clinical setting are unpr oved. These effects were examined, focusing on inflammatory cytokine and ni tric oxide metabolism. Methods: Twenty-four cirrhotic patients with hepatocellular carcinoma under going subsegmentectomy under ischemia induced only by Pringle's maneuver we re divided into two groups (patients given prostaglandin E1 by injection an d untreated controls) and postoperative results were compared. Peripheral b lood was taken perioperatively and the plasma aminotransferase, cytokines a nd nitrate/nitrite levels of the two groups were compared. Two liver specim ens were taken from each patient, one before ischemia and the other after h epatectomy, and the levels of inducible nitric oxide synthase and cytokine mRNAs and proteins were analyzed. Results: Although no apparent differences were recognized in postoperative complications or duration of postoperative hospital stay between the groups , the perioperative plasma aminotransferase level was significantly lower i n the prostaglandin E1 group. Significant differences were also seen in int erleukin-6 and nitrate plasma levels during the observation period and the interleukin-6 protein levels in the liver supernatants after hepatectomy in the two groups. In contrast, no significant differences were apparent betw een the interleukin-1 beta and tumor necrosis factor-alpha plasma levels of the two groups. The corrected fluorescence activities of interleukin-6 and inducible nitric oxide synthase mRNAs in the liver after hepatectomy corre lated significantly. No interleukin-1 beta or tumor necrosis factor-alpha m RNAs or proteins were detected. Conclusions: Prostaglandin E1 exerted hepatoprotective effects on livers su ffering from ischemia/reperfusion injury, and interleukin-6 might play an i mportant role in these effects.