Continuous Venous Infusion of Adenosine in Patients Undergoing Partial Liver-Resection - a Potential Method to Reduce Ischemia-Reperfusion Damage?

Purpose: Hepatic ischemia-reperfusion injury following Pringle maneuver during liver surgery has significant impact on postoperative hepatic function. The purpose of this study was to determine if continuously infused adenosine can prevent/reduce the hepatic ischemia-reperfusion injury. Method: This study focused on the pharmacological preand/or post-conditioning by intra venous adenosine infusion in 23 humans scheduled for liver surgery including Pringle's maneuver. Result: Plasma adenosine concentrations measured in central venous and arterial samples revealed a clearance of adenosine of almost 94% after lung passage in the arterial samples. Adenosine plasma concentrations in portal venous samples were not affected by adenosine infusion. Inflammatory, hepatocellular and ischemic markers were not different between the control group, the preconditioning group or the preand post-conditioning group. Conclusion: This preliminary study shows that high doses of central-venous infused adenosine could neither affect systemic inflammation nor the degree of effector organ (liver) damage as a result of surgical trauma and ischemia and reperfusion. Because of the impossibility of sufficient systematic metabolic tissue monitoring, the absence of hepatic effects might be best attributed to non-sufficiently high concentrations of adenosine at the target organ.