The effect of pringle maneuver applied during living donor hepatectomy on the ischemia-reperfusion injury observed in the donors and recipients

Aim: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Material and Method: A total of 108 patients, 54 donors who underwent donor hepatectomy and 54 recipients who underwent living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n=27) and Pringle maneuver not applied (n=27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as Pringle maneuver performed (n=27) and not performed (n=27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0. hour, post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day and liver tissue was taken from the graft during the back table procedures. Routine tests such as hemogram and biochemical analysis, IL-1, IL-2, IL-6, TNF-α, and β-galactosidase measurements and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all time periods in the donors with and without Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p=0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p=0.001). Conclusion: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not have an adverse effect on ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses. Key Words: Ischemia-reperfusion injury, liver transplantation, Pringle maneuver