Ischemic preconditioning of the liver: From molecular bases to clinical application

Ischemia-reperfusion injury is produced when an organ is deprived of blood flow (ischemia), which is then restored (reperfusion). In certain circumstances, this injury leads to irreversible organ damage. Several therapeutic strategies have been used to reduce the severity of this injury. One of these strategies is the application of brief and repetitive episodes of ischemia-reperfusion before prolonged ischemia-reperfusion (ischemic preconditioning). In the present article we review the molecular mechanisms through which ischemic preconditioning confers protection against ischemia-reperfusion injury. The application of ischemic preconditioning during liver surgery is discussed, both in normothermic situations such as liver resection and in situations of low temperature such as liver transplantation.