Scolaris Content Display Scolaris Content Display

Figure 01
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Figure 1

Figure 01

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 1 Mortality.
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Analysis 1.1

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 1 Mortality.

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 2 Liver failure.
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Analysis 1.2

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 2 Liver failure.

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 3 Other Morbidity.
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Analysis 1.3

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 3 Other Morbidity.

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 4 Blood loss.
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Analysis 1.4

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 4 Blood loss.

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 5 Number needing transfusion.
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Analysis 1.5

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 5 Number needing transfusion.

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 6 Number of units transfused.
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Analysis 1.6

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 6 Number of units transfused.

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 7 Haemodynamic Changes (10 min).
Figures and Tables -
Analysis 1.7

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 7 Haemodynamic Changes (10 min).

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 8 AST (IU/L).
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Analysis 1.8

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 8 AST (IU/L).

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 9 ALT (IU/L).
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Analysis 1.9

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 9 ALT (IU/L).

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 10 Bilirubin (micromole/litre).
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Analysis 1.10

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 10 Bilirubin (micromole/litre).

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 11 Prothrombin time (percentage of normal).
Figures and Tables -
Analysis 1.11

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 11 Prothrombin time (percentage of normal).

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 12 Increase in lactate (mmol/L) (Systemic).
Figures and Tables -
Analysis 1.12

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 12 Increase in lactate (mmol/L) (Systemic).

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 13 Increase in lactate (mmol/L) (Portal).
Figures and Tables -
Analysis 1.13

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 13 Increase in lactate (mmol/L) (Portal).

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 14 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue).
Figures and Tables -
Analysis 1.14

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 14 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue).

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 15 CD18 (Relative fluorescence units).
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Analysis 1.15

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 15 CD18 (Relative fluorescence units).

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 16 Inosine (Portal vein ‐ arterial) nmol/litre.
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Analysis 1.16

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 16 Inosine (Portal vein ‐ arterial) nmol/litre.

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 17 Hypoxanthine (Portal vein ‐ arterial) micromol/litre.
Figures and Tables -
Analysis 1.17

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 17 Hypoxanthine (Portal vein ‐ arterial) micromol/litre.

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 18 Xanthine (Portal vein ‐ arterial) micromol/litre.
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Analysis 1.18

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 18 Xanthine (Portal vein ‐ arterial) micromol/litre.

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 19 Operating time (in minutes).
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Analysis 1.19

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 19 Operating time (in minutes).

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 20 Hospital Stay (in days).
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Analysis 1.20

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 20 Hospital Stay (in days).

Comparison 2 Vascular occlusion versus 'no vascular occlusion' (Major resections), Outcome 1 Mortality.
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Analysis 2.1

Comparison 2 Vascular occlusion versus 'no vascular occlusion' (Major resections), Outcome 1 Mortality.

Comparison 2 Vascular occlusion versus 'no vascular occlusion' (Major resections), Outcome 2 Number needing transfusion.
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Analysis 2.2

Comparison 2 Vascular occlusion versus 'no vascular occlusion' (Major resections), Outcome 2 Number needing transfusion.

Comparison 2 Vascular occlusion versus 'no vascular occlusion' (Major resections), Outcome 3 Number of units transfused.
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Analysis 2.3

Comparison 2 Vascular occlusion versus 'no vascular occlusion' (Major resections), Outcome 3 Number of units transfused.

Comparison 2 Vascular occlusion versus 'no vascular occlusion' (Major resections), Outcome 4 Operating time (in minutes).
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Analysis 2.4

Comparison 2 Vascular occlusion versus 'no vascular occlusion' (Major resections), Outcome 4 Operating time (in minutes).

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 1 Mortality.
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Analysis 3.1

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 1 Mortality.

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 2 Blood loss.
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Analysis 3.2

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 2 Blood loss.

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 3 Number needing transfusion.
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Analysis 3.3

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 3 Number needing transfusion.

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 4 Number of units transfused.
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Analysis 3.4

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 4 Number of units transfused.

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 5 Haemodynamic Changes (10 min).
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Analysis 3.5

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 5 Haemodynamic Changes (10 min).

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 6 AST (IU/L).
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Analysis 3.6

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 6 AST (IU/L).

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 7 ALT (IU/L).
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Analysis 3.7

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 7 ALT (IU/L).

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 8 Increase in lactate (mmol/L) (Systemic).
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Analysis 3.8

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 8 Increase in lactate (mmol/L) (Systemic).

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 9 Increase in lactate (mmol/L) (Portal).
Figures and Tables -
Analysis 3.9

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 9 Increase in lactate (mmol/L) (Portal).

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 10 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue).
Figures and Tables -
Analysis 3.10

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 10 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue).

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 11 CD18 (Relative fluorescence units).
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Analysis 3.11

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 11 CD18 (Relative fluorescence units).

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 12 Inosine (Portal vein ‐ arterial) nmol/litre.
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Analysis 3.12

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 12 Inosine (Portal vein ‐ arterial) nmol/litre.

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 13 Hypoxanthine (Portal vein ‐ arterial) micromol/litre.
Figures and Tables -
Analysis 3.13

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 13 Hypoxanthine (Portal vein ‐ arterial) micromol/litre.

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 14 Xanthine (Portal vein ‐ arterial) micromol/litre.
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Analysis 3.14

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 14 Xanthine (Portal vein ‐ arterial) micromol/litre.

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 15 Operating time (in minutes).
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Analysis 3.15

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 15 Operating time (in minutes).

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 16 Hospital Stay (in days).
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Analysis 3.16

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 16 Hospital Stay (in days).

Comparison 4 Vascular occlusion versus 'no vascular occlusion' (Cirrhotic), Outcome 1 Mortality.
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Analysis 4.1

Comparison 4 Vascular occlusion versus 'no vascular occlusion' (Cirrhotic), Outcome 1 Mortality.

Comparison 4 Vascular occlusion versus 'no vascular occlusion' (Cirrhotic), Outcome 2 Number needing transfusion.
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Analysis 4.2

Comparison 4 Vascular occlusion versus 'no vascular occlusion' (Cirrhotic), Outcome 2 Number needing transfusion.

Comparison 4 Vascular occlusion versus 'no vascular occlusion' (Cirrhotic), Outcome 3 Number of units transfused.
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Analysis 4.3

Comparison 4 Vascular occlusion versus 'no vascular occlusion' (Cirrhotic), Outcome 3 Number of units transfused.

Comparison 4 Vascular occlusion versus 'no vascular occlusion' (Cirrhotic), Outcome 4 Operating time (in minutes).
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Analysis 4.4

Comparison 4 Vascular occlusion versus 'no vascular occlusion' (Cirrhotic), Outcome 4 Operating time (in minutes).

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 1 Mortality.
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Analysis 5.1

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 1 Mortality.

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 2 Liver failure.
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Analysis 5.2

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 2 Liver failure.

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 3 Other Morbidity.
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Analysis 5.3

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 3 Other Morbidity.

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 4 Blood loss.
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Analysis 5.4

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 4 Blood loss.

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 5 Number needing transfusion.
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Analysis 5.5

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 5 Number needing transfusion.

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 6 Number of units transfused.
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Analysis 5.6

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 6 Number of units transfused.

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 7 Haemodynamic Changes (10 min).
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Analysis 5.7

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 7 Haemodynamic Changes (10 min).

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 8 AST (IU/L).
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Analysis 5.8

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 8 AST (IU/L).

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 9 ALT (IU/L).
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Analysis 5.9

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 9 ALT (IU/L).

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 10 Bilirubin (micromole/litre).
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Analysis 5.10

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 10 Bilirubin (micromole/litre).

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 11 Prothrombin time (percentage of normal).
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Analysis 5.11

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 11 Prothrombin time (percentage of normal).

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 12 Increase in lactate (mmol/L) (Systemic).
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Analysis 5.12

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 12 Increase in lactate (mmol/L) (Systemic).

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 13 Increase in lactate (mmol/L) (Portal).
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Analysis 5.13

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 13 Increase in lactate (mmol/L) (Portal).

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 14 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue).
Figures and Tables -
Analysis 5.14

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 14 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue).

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 15 CD18 (Relative fluorescence units).
Figures and Tables -
Analysis 5.15

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 15 CD18 (Relative fluorescence units).

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 16 Inosine (Portal vein ‐ arterial) nmol/litre.
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Analysis 5.16

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 16 Inosine (Portal vein ‐ arterial) nmol/litre.

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 17 Hypoxanthine (Portal vein ‐ arterial) micromol/litre.
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Analysis 5.17

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 17 Hypoxanthine (Portal vein ‐ arterial) micromol/litre.

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 18 Xanthine (Portal vein ‐ arterial) micromol/litre.
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Analysis 5.18

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 18 Xanthine (Portal vein ‐ arterial) micromol/litre.

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 19 Hospital Stay (in days).
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Analysis 5.19

Comparison 5 Intermittent vascular occlusion versus 'no vascular occlusion', Outcome 19 Hospital Stay (in days).

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 1 Mortality.
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Analysis 6.1

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 1 Mortality.

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 2 Liver failure.
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Analysis 6.2

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 2 Liver failure.

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 3 Peri‐operative Morbidity.
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Analysis 6.3

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 3 Peri‐operative Morbidity.

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 4 Blood loss (ml).
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Analysis 6.4

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 4 Blood loss (ml).

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 5 Number of units transfused.
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Analysis 6.5

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 5 Number of units transfused.

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 6 Number needing transfusion.
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Analysis 6.6

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 6 Number needing transfusion.

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 7 Haemodynamic Changes.
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Analysis 6.7

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 7 Haemodynamic Changes.

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 8 AST (IU/L).
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Analysis 6.8

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 8 AST (IU/L).

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 9 Prothrombin time (percentage of normal).
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Analysis 6.9

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 9 Prothrombin time (percentage of normal).

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 10 Creatinine (micromole/litre).
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Analysis 6.10

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 10 Creatinine (micromole/litre).

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 11 Operating Time (minutes).
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Analysis 6.11

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 11 Operating Time (minutes).

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 12 Hospital Stay (days).
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Analysis 6.12

Comparison 6 Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC), Outcome 12 Hospital Stay (days).

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 1 Mortality.
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Analysis 7.1

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 1 Mortality.

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 2 Liver failure.
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Analysis 7.2

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 2 Liver failure.

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 3 Other Morbidity.
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Analysis 7.3

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 3 Other Morbidity.

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 4 Blood loss (ml).
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Analysis 7.4

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 4 Blood loss (ml).

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 5 Number of units transfused.
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Analysis 7.5

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 5 Number of units transfused.

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 6 Number needing Transfusion.
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Analysis 7.6

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 6 Number needing Transfusion.

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 7 Hemodynamics change (10 min after clamping).
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Analysis 7.7

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 7 Hemodynamics change (10 min after clamping).

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 8 Hemodynamics change (10 min after release of clamping).
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Analysis 7.8

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 8 Hemodynamics change (10 min after release of clamping).

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 9 AST (IU/L).
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Analysis 7.9

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 9 AST (IU/L).

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 10 ALT (IU/L).
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Analysis 7.10

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 10 ALT (IU/L).

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 11 Operating time (min).
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Analysis 7.11

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 11 Operating time (min).

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 12 Hospital Stay (in days).
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Analysis 7.12

Comparison 7 Inflow occlusion: 'total' versus 'selective', Outcome 12 Hospital Stay (in days).

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 1 Mortality.
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Analysis 8.1

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 1 Mortality.

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 2 Liver failure.
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Analysis 8.2

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 2 Liver failure.

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 3 Other Morbidity.
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Analysis 8.3

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 3 Other Morbidity.

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 4 Blood loss (ml).
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Analysis 8.4

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 4 Blood loss (ml).

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 5 Number of units transfused.
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Analysis 8.5

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 5 Number of units transfused.

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 6 Number needing Transfusion.
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Analysis 8.6

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 6 Number needing Transfusion.

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 7 Hemodynamics change (10 min after clamping).
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Analysis 8.7

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 7 Hemodynamics change (10 min after clamping).

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 8 Hemodynamics change (10 min after release of clamping).
Figures and Tables -
Analysis 8.8

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 8 Hemodynamics change (10 min after release of clamping).

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 9 AST (IU/L).
Figures and Tables -
Analysis 8.9

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 9 AST (IU/L).

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 10 ALT (IU/L).
Figures and Tables -
Analysis 8.10

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 10 ALT (IU/L).

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 11 Operating time (min).
Figures and Tables -
Analysis 8.11

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 11 Operating time (min).

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 12 Hospital Stay (in days).
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Analysis 8.12

Comparison 8 Inflow occlusion: 'total' versus 'selective' (Minor resections), Outcome 12 Hospital Stay (in days).

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 1 Mortality.
Figures and Tables -
Analysis 9.1

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 1 Mortality.

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 2 Other Morbidity.
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Analysis 9.2

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 2 Other Morbidity.

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 3 Blood loss (ml).
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Analysis 9.3

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 3 Blood loss (ml).

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 4 Number needing Transfusion.
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Analysis 9.4

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 4 Number needing Transfusion.

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 5 AST (IU/L).
Figures and Tables -
Analysis 9.5

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 5 AST (IU/L).

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 6 ALT (IU/L).
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Analysis 9.6

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 6 ALT (IU/L).

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 7 Operating time (min).
Figures and Tables -
Analysis 9.7

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 7 Operating time (min).

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 8 Hospital Stay (in days).
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Analysis 9.8

Comparison 9 Inflow occlusion: 'total' versus 'selective' (Cirrhotic), Outcome 8 Hospital Stay (in days).

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 1 Mortality.
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Analysis 10.1

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 1 Mortality.

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 2 Liver failure.
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Analysis 10.2

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 2 Liver failure.

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 3 Other Morbidity.
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Analysis 10.3

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 3 Other Morbidity.

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 4 Blood loss.
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Analysis 10.4

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 4 Blood loss.

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 5 Number needing transfusion.
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Analysis 10.5

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 5 Number needing transfusion.

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 6 Number of units transfused.
Figures and Tables -
Analysis 10.6

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 6 Number of units transfused.

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 7 AST (IU/L).
Figures and Tables -
Analysis 10.7

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 7 AST (IU/L).

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 8 ALT (IU/L).
Figures and Tables -
Analysis 10.8

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 8 ALT (IU/L).

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 9 Bilirubin (micromole/litre).
Figures and Tables -
Analysis 10.9

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 9 Bilirubin (micromole/litre).

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 10 Prothrombin time (percentage of normal).
Figures and Tables -
Analysis 10.10

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 10 Prothrombin time (percentage of normal).

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 11 Operating time (in minutes).
Figures and Tables -
Analysis 10.11

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 11 Operating time (in minutes).

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 12 Hospital Stay (in days).
Figures and Tables -
Analysis 10.12

Comparison 10 Portal triad clamping: 'continuous' versus 'intermittent', Outcome 12 Hospital Stay (in days).

Comparison 11 Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic), Outcome 1 Mortality.
Figures and Tables -
Analysis 11.1

Comparison 11 Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic), Outcome 1 Mortality.

Comparison 11 Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic), Outcome 2 Blood loss.
Figures and Tables -
Analysis 11.2

Comparison 11 Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic), Outcome 2 Blood loss.

Comparison 11 Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic), Outcome 3 Number needing transfusion.
Figures and Tables -
Analysis 11.3

Comparison 11 Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic), Outcome 3 Number needing transfusion.

Comparison 11 Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic), Outcome 4 Number of units transfused.
Figures and Tables -
Analysis 11.4

Comparison 11 Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic), Outcome 4 Number of units transfused.

Comparison 11 Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic), Outcome 5 Operating time (in minutes).
Figures and Tables -
Analysis 11.5

Comparison 11 Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic), Outcome 5 Operating time (in minutes).

Comparison 12 30 minute intermittent PTC (30 min IPTC) versus 15 minute intermittent PTC (15 min IPTC), Outcome 1 Surgical morbidity.
Figures and Tables -
Analysis 12.1

Comparison 12 30 minute intermittent PTC (30 min IPTC) versus 15 minute intermittent PTC (15 min IPTC), Outcome 1 Surgical morbidity.

Comparison 12 30 minute intermittent PTC (30 min IPTC) versus 15 minute intermittent PTC (15 min IPTC), Outcome 2 Number requiring blood transfusion.
Figures and Tables -
Analysis 12.2

Comparison 12 30 minute intermittent PTC (30 min IPTC) versus 15 minute intermittent PTC (15 min IPTC), Outcome 2 Number requiring blood transfusion.

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 1 Mortality.
Figures and Tables -
Analysis 13.1

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 1 Mortality.

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 2 Liver failure.
Figures and Tables -
Analysis 13.2

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 2 Liver failure.

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 3 Other Morbidity.
Figures and Tables -
Analysis 13.3

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 3 Other Morbidity.

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 4 Blood loss (ml).
Figures and Tables -
Analysis 13.4

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 4 Blood loss (ml).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 5 Number of units transfused.
Figures and Tables -
Analysis 13.5

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 5 Number of units transfused.

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 6 Number needing Transfusion.
Figures and Tables -
Analysis 13.6

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 6 Number needing Transfusion.

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 7 Haemodynamic Changes (10 min).
Figures and Tables -
Analysis 13.7

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 7 Haemodynamic Changes (10 min).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 8 AST (IU/L).
Figures and Tables -
Analysis 13.8

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 8 AST (IU/L).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 9 ALT (IU/L).
Figures and Tables -
Analysis 13.9

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 9 ALT (IU/L).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 10 Alpha Glutathione S‐tranferase (IU/L).
Figures and Tables -
Analysis 13.10

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 10 Alpha Glutathione S‐tranferase (IU/L).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 11 Bilirubin (micromole/litre).
Figures and Tables -
Analysis 13.11

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 11 Bilirubin (micromole/litre).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 12 Prothrombin time (percentage of normal).
Figures and Tables -
Analysis 13.12

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 12 Prothrombin time (percentage of normal).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 13 Creatinine (micromoles/litre).
Figures and Tables -
Analysis 13.13

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 13 Creatinine (micromoles/litre).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 14 Increase in lactate (mmol/L) (Systemic).
Figures and Tables -
Analysis 13.14

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 14 Increase in lactate (mmol/L) (Systemic).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 15 Increase in lactate (mmol/L) (Portal).
Figures and Tables -
Analysis 13.15

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 15 Increase in lactate (mmol/L) (Portal).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 16 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue).
Figures and Tables -
Analysis 13.16

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 16 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 17 CD18 (Relative fluorescence units).
Figures and Tables -
Analysis 13.17

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 17 CD18 (Relative fluorescence units).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 18 Inosine (Portal vein ‐ arterial) nmol/litre.
Figures and Tables -
Analysis 13.18

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 18 Inosine (Portal vein ‐ arterial) nmol/litre.

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 19 Hypoxanthine (Portal vein ‐ arterial) micromol/litre.
Figures and Tables -
Analysis 13.19

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 19 Hypoxanthine (Portal vein ‐ arterial) micromol/litre.

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 20 Xanthine (Portal vein ‐ arterial) micromol/litre.
Figures and Tables -
Analysis 13.20

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 20 Xanthine (Portal vein ‐ arterial) micromol/litre.

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 24 ITU stay (in days).
Figures and Tables -
Analysis 13.24

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 24 ITU stay (in days).

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 25 Hospital Stay (in days).
Figures and Tables -
Analysis 13.25

Comparison 13 Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion), Outcome 25 Hospital Stay (in days).

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 1 Mortality.
Figures and Tables -
Analysis 14.1

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 1 Mortality.

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 2 Liver failure.
Figures and Tables -
Analysis 14.2

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 2 Liver failure.

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 3 Other morbidity.
Figures and Tables -
Analysis 14.3

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 3 Other morbidity.

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 4 Blood loss (ml).
Figures and Tables -
Analysis 14.4

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 4 Blood loss (ml).

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 5 Number of units transfused.
Figures and Tables -
Analysis 14.5

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 5 Number of units transfused.

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 6 AST (IU/L).
Figures and Tables -
Analysis 14.6

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 6 AST (IU/L).

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 7 ALT (IU/L).
Figures and Tables -
Analysis 14.7

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 7 ALT (IU/L).

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 8 Alpha Glutathione S‐tranferase (IU/L).
Figures and Tables -
Analysis 14.8

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 8 Alpha Glutathione S‐tranferase (IU/L).

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 9 Bilirubin (micromole/litre).
Figures and Tables -
Analysis 14.9

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 9 Bilirubin (micromole/litre).

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 10 Prothrombin time (percentage of normal).
Figures and Tables -
Analysis 14.10

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 10 Prothrombin time (percentage of normal).

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 11 Hospital Stay (in days).
Figures and Tables -
Analysis 14.11

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 11 Hospital Stay (in days).

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 12 ITU stay (in days).
Figures and Tables -
Analysis 14.12

Comparison 14 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections), Outcome 12 ITU stay (in days).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 1 Mortality.
Figures and Tables -
Analysis 15.1

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 1 Mortality.

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 2 Liver failure.
Figures and Tables -
Analysis 15.2

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 2 Liver failure.

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 3 Other Morbidity.
Figures and Tables -
Analysis 15.3

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 3 Other Morbidity.

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 4 Blood loss (ml).
Figures and Tables -
Analysis 15.4

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 4 Blood loss (ml).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 5 Number of units transfused.
Figures and Tables -
Analysis 15.5

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 5 Number of units transfused.

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 6 Number needing Transfusion.
Figures and Tables -
Analysis 15.6

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 6 Number needing Transfusion.

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 7 Haemodynamic Changes (10 min).
Figures and Tables -
Analysis 15.7

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 7 Haemodynamic Changes (10 min).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 8 AST (IU/L).
Figures and Tables -
Analysis 15.8

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 8 AST (IU/L).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 9 ALT (IU/L).
Figures and Tables -
Analysis 15.9

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 9 ALT (IU/L).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 10 Alpha Glutathione S‐tranferase (IU/L).
Figures and Tables -
Analysis 15.10

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 10 Alpha Glutathione S‐tranferase (IU/L).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 11 Bilirubin (micromole/litre).
Figures and Tables -
Analysis 15.11

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 11 Bilirubin (micromole/litre).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 12 Prothrombin time (percentage of normal).
Figures and Tables -
Analysis 15.12

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 12 Prothrombin time (percentage of normal).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 13 Creatinine (micromoles/litre).
Figures and Tables -
Analysis 15.13

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 13 Creatinine (micromoles/litre).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 14 Increase in lactate (mmol/L) (Systemic).
Figures and Tables -
Analysis 15.14

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 14 Increase in lactate (mmol/L) (Systemic).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 15 Increase in lactate (mmol/L) (Portal).
Figures and Tables -
Analysis 15.15

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 15 Increase in lactate (mmol/L) (Portal).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 16 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue).
Figures and Tables -
Analysis 15.16

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 16 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 17 CD18 (Relative fluorescence units).
Figures and Tables -
Analysis 15.17

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 17 CD18 (Relative fluorescence units).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 18 Inosine (Portal vein ‐ arterial) nmol/litre.
Figures and Tables -
Analysis 15.18

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 18 Inosine (Portal vein ‐ arterial) nmol/litre.

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 19 Hypoxanthine (Portal vein ‐ arterial) micromol/litre.
Figures and Tables -
Analysis 15.19

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 19 Hypoxanthine (Portal vein ‐ arterial) micromol/litre.

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 20 Xanthine (Portal vein ‐ arterial) micromol/litre.
Figures and Tables -
Analysis 15.20

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 20 Xanthine (Portal vein ‐ arterial) micromol/litre.

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 21 ITU stay (in days).
Figures and Tables -
Analysis 15.21

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 21 ITU stay (in days).

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 22 Hospital Stay (in days).
Figures and Tables -
Analysis 15.22

Comparison 15 Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic), Outcome 22 Hospital Stay (in days).

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 1 Mortality.
Figures and Tables -
Analysis 16.1

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 1 Mortality.

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 2 Liver failure.
Figures and Tables -
Analysis 16.2

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 2 Liver failure.

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 3 Other morbidity.
Figures and Tables -
Analysis 16.3

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 3 Other morbidity.

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 4 Blood loss (ml).
Figures and Tables -
Analysis 16.4

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 4 Blood loss (ml).

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 5 Number of units transfused.
Figures and Tables -
Analysis 16.5

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 5 Number of units transfused.

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 6 Number needing transfusion.
Figures and Tables -
Analysis 16.6

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 6 Number needing transfusion.

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 7 AST (IU/L).
Figures and Tables -
Analysis 16.7

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 7 AST (IU/L).

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 8 ALT (IU/L).
Figures and Tables -
Analysis 16.8

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 8 ALT (IU/L).

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 9 Bilirubin (micromole/litre).
Figures and Tables -
Analysis 16.9

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 9 Bilirubin (micromole/litre).

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 10 Prothrombin time (percentage of normal).
Figures and Tables -
Analysis 16.10

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 10 Prothrombin time (percentage of normal).

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 11 Caspase‐3.
Figures and Tables -
Analysis 16.11

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 11 Caspase‐3.

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 12 Apoptotic bodies.
Figures and Tables -
Analysis 16.12

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 12 Apoptotic bodies.

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 13 Operating time.
Figures and Tables -
Analysis 16.13

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 13 Operating time.

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 14 ITU stay (in days).
Figures and Tables -
Analysis 16.14

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 14 ITU stay (in days).

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 15 Hospital stay (in days).
Figures and Tables -
Analysis 16.15

Comparison 16 Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC), Outcome 15 Hospital stay (in days).

Table 1. Search strategies for identification of studies

Database

Period

Search strategy used

The Cochrane Hepato‐Biliary Group Controlled Trials Register

March 2007.

#1 ((occlusion OR clamping OR exclusion) AND (vascular OR vessel OR arter* OR venous OR vein OR hepatic or portal)) OR pringle
#2 (ischaemi* OR ischemi*) AND precondition*
#3 #1 OR #2
#4 liver OR hepatic
#5 segmentectomy OR resection OR transplant* OR graft*
#6 #4 AND #5
#7 #3 AND #6

Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library

Issue 1, 2007.

#1 ((occlusion OR clamping OR exclusion) AND (vascular OR vessel OR arter* OR venous OR vein OR hepatic or portal)) OR pringle in All Fields in all products
#2 (ischaemi* OR ischemi*) AND precondition* in All Fields in all products
#3 MeSH descriptor Ischemic Preconditioning explode all trees in MeSH products
#4 MeSH descriptor Ischemia explode all trees in MeSH products
#5 (#1 OR #2 OR #3 OR #4)
#6 liver OR hepatic in All Fields in all products
#7 MeSH descriptor Liver explode all trees in MeSH products
#8 MeSH descriptor Liver Diseases explode all trees in MeSH products
#9 MeSH descriptor Liver Neoplasms explode all trees in MeSH products
#10 (#6 OR #7 OR #8 OR #9)
#11 segmentectomy OR resection OR transplant* OR graft* in All Fields in all products
#12 (#10 AND #11)
#13 MeSH descriptor Hepatectomy explode all trees in MeSH products
#14 MeSH descriptor Liver Transplantation explode all trees in MeSH products
#15 (#12 OR #13 OR #14)
#16 (#5 AND #15)

MEDLINE

January 1950 to March 2007.

((((occlusion OR clamping OR exclusion) AND (vascular OR vessel OR arter* OR venous OR vein OR hepatic or portal)) OR pringle) OR (((ischaemi* OR ischemi*) AND precondition*) OR "ischemic preconditioning"[MeSH Terms] OR "ischemia"[MeSH Terms]) AND ((("Liver"[MeSH] OR "Liver Neoplasms"[MeSH] OR "Liver Diseases"[MeSH] OR liver OR hepatic) AND (segmentectomy OR resection OR transplant* OR graft*)) OR "Hepatectomy"[MeSH] OR "Liver Transplantation"[MeSH])) AND (((randomized controlled trial [pt] OR controlled clinical trial [pt] OR randomized controlled trials [mh] OR random allocation [mh] OR double‐blind method [mh] OR single‐blind method [mh] OR clinical trial [pt] OR clinical trials [mh] OR ("clinical trial" [tw]) OR ((singl* [tw] OR doubl* [tw] OR trebl* [tw] OR tripl* [tw]) AND (mask* [tw] OR blind* [tw])) OR (placebos [mh] OR placebo* [tw] OR random* [tw] OR research design [mh:noexp]) NOT (animals [mh] NOT human [mh]))))

EMBASE

January 1974 to March 2007.

1 (occlusion OR clamping OR exclusion) AND (vascular OR vessel OR arter$ OR venous OR vein OR hepatic OR portal) OR pringle OR (ischaemi$ OR ischemi$) AND precondition$
2 REPERFUSION‐INJURY#.DE. OR ISCHEMIC‐PRECONDITIONING#.DE. OR ISCHEMIA#.W..DE.
3 1 OR 2
4 LIVER OR HEPATIC OR HEPATO
5 SEGMENTECTOMY OR RESECTION
6 4 AND 5
7 HEPATECTOMY OR LIVER‐RESECTION.DE.
8 6 OR 7
9 3 AND 8
10 RANDOMIZED‐CONTROLLED‐TRIAL#.DE. OR RANDOMIZATION#.W..DE. OR CONTROLLED‐STUDY#.DE. OR MULTICENTER‐STUDY#.DE. OR PHASE‐3‐CLINICAL‐TRIAL#.DE. OR PHASE‐4‐CLINICAL‐TRIAL#.DE. OR DOUBLE‐BLIND‐PROCEDURE#.DE. OR SINGLE‐BLIND‐PROCEDURE#.DE.
11 RANDOM$ OR CROSSOVER$ OR CROSS‐OVER OR CROSS ADJ OVER OR FACTORIAL$ OR PLACEBO$ OR VOLUNTEER$
12 (SINGLE OR DOUBLE OR TREBLE OR TRIPLE) NEAR (BLIND OR MASK)
13 10 OR 11 OR 12
14 13 AND HUMAN=YES
15 9 AND 14

Science Citation Index Expanded (http://portal.isiknowledge.com/portal.cgi?DestApp=WOS&Func=Frame)

January 1970 to March 2007.

#1 TS=(((occlusion OR clamping OR exclusion) AND (vascular OR vessel OR arter* OR venous OR vein OR hepatic or portal)) OR pringle)
#2 TS=((ischaemi* OR ischemi*) AND precondition*)
#3 #2 OR #1
#4 TS=(liver OR hepatic)
#5 TS=(segmentectomy OR resection OR transplant* OR graft*)
#6 #5 AND #4
#7 #6 AND #3
#8 TS=(random* OR blind*OR placebo* OR meta‐analysis)
#9 #8 AND #7

Figures and Tables -
Table 1. Search strategies for identification of studies
Table 2. Mortality and causes

Study

Intervention

Causes

Control

Causes

Abbreviations

HVE = hepatic vascular exclusion
PTC = portal triad clamping
IPC = ischaemic pre‐conditioning

VASCULAR OCCLUSION vs NO VASCULAR OCCLUSION

Capussotti 2006

1

Respiratory failure

1

Portal vein thrombosis (Low CVP used)

Chouker 2005

0

0

Clavien 1996

0

0

Man 1997

1

Subphrenic abscess ‐ septicaemia

2

1 superior mesenteric vein thrombosis (liver failure) No details of whether low CVP was used 1 renal failure

Man 2003

0

1

Cause not stated

HVE vs PTC

Belghiti 1996

0

1

Renal failure

Chen 2006

0

1

Hepatic failure

PTC ‐ TOTAL vs SELECTIVE

Figueras 2005

0

1

Liver insufficiency (in cirrhotic liver)

Wu 2002

0

0

PTC ‐ CONTINUOUS vs INTERMITTENT

Belghiti 1999

2

Liver failure (cirrhotic livers)

0

Capussotti 2003

2

1 ‐ case of portal vein thrombosis 1 ‐ Bleeding from cut surface. (No details of whether low CVP was used)

0

INTERMITTENT PTC ‐ 30 min vs 15 min

Esaki 2006

0

0

IPC vs NO IPC

Azoulay 2006

2

1 ‐ Liver failure 1 ‐ Ischaemic perforation of right colon (No details of whether low CVP was used)

0

Chouker 2005

0

0

Clavien 2003

0

0

IPC vs INTERMITTENT PTC

Petrowsky 2006

1

Intestinal ischaemia

0

Smyrniotis 2006

0

0

Figures and Tables -
Table 2. Mortality and causes
Table 3. "Vascular occlusion" versus "No vascular occlusion"

Outcome

Number of studies

Number of patients

OR or WMD

Major resections

Non‐cirrhotic livers

Cirrhotic livers

Other studies

MORTALITY

5

331

0.55 [0.11, 2.61]

Not estimable
(n = 15)

Not estimable
(n = 59)

Not estimable
(n = 6)

MORBIDITY

Liver failure

1

126

0.48 [0.09, 2.74]

Abdominal collection

1

126

1.19 [0.38, 3.75]

Bleeding

1

100

3.06 [0.12, 76.95]

Biliary fistula

2

226

1.53 [0.42, 5.62]

Wound infection

1

100

0.73 [0.16, 3.46]

Uraemia

1

100

0.33 [0.01, 8.21]

Pulmonary

2

226

0.96 [0.19, 4.96]

BLOOD LOSS (ml)

Transection

2

176

‐328.04 [‐973.40, 317.31]

‐680.00 [‐1022.34, ‐337.66]*
(n = 50)

610 vs 1410* (Man 1997)
( n = 100)

Operative

1

50

‐790.00 [‐1223.54, ‐356.46]*

‐790.00 [‐1223.54, ‐356.46]*
(n = 50)

1280 vs 1990*(Man 1997)
( n = 100)
8.9 /sq cm vs 12.4 / sq cm* (Man 2003)
( n = 40)

Number needing transfusion

5

331

0.38 [0.10, 1.46]

0.25 [0.03, 2.24]
(n = 15)

0.15 [0.04, 0.63]*
(n = 59)

0.25 [0.01, 7.45]
(n = 6)

Number of units transfused

2

141

‐0.60 [‐1.44, 0.24]

‐0.60 [‐3.20, 2.00]
(n = 15)

‐2.00 [‐5.69, 1.69]
(n = 9)

1.30 [‐2.72, 5.32]
(n = 6)

HAEMODYNAMIC CHANGES (during occlusion)

Mean Arterial Pressure (mmHg)

1

8

12.10 [‐4.57, 28.77]

12.10 [‐4.57, 28.77]
(n = 8)

Cardiac Index (Litre/min/m2)

1

8

‐0.15 [‐1.47, 1.17]

‐0.15 [‐1.47, 1.17]
(n = 8)

Stroke Volume (ml/ m2)

1

8

194.00 [‐94.17, 482.17]

194.00 [‐94.17, 482.17]
(n = 8)

Systemic Vascular resistance Index (dynes.sec. 104/cm3)

1

8

‐7.20 [‐22.06, 7.66]

‐7.20 [‐22.06, 7.66]
(n = 8)

LIVER FUNCTION TESTS

AST (IU/L)

1st POD

1

50

254.00 [43.41, 464.59]*

254.00 [43.41, 464.59]*
(n = 50)

2nd POD

1

50

158.00 [20.38, 295.62]*

158.00 [20.38, 295.62]*
(n = 50)

3rd POD

1

126

14.30 [‐12.43, 41.03]

7th POD

1

126

3.50 [‐31.61, 38.61]

ALT (IU/L)

1st POD

1

50

265.10 [48.84, 481.36]*

265.10 [48.84, 481.36]*
(n = 50)

2nd POD

1

50

301.20 [‐2.48, 604.88]

301.20 [‐2.48, 604.88]
(n = 50)

3rd POD

1

126

46.00 [‐12.24, 104.24]

7th POD

1

126

10.40 [‐30.12, 50.92]

Peak

380 vs 150* (Man 1997)
( n = 100)

Bilirubin (micromole / litre)

2nd POD

26 vs 35 (Man 2003)
( n = 40)

3rd POD

1

126

‐0.20 [‐0.69, 0.29]

7th POD

1

126

‐0.30 [‐0.79, 0.19]

Peak

31.8 vs 34.4* (Man 1997)
( n = 100)

Prothrombin time (as percentage of normal function)

3rd POD

1

126

2.10 [‐2.22, 6.42]

7th POD

1

126

3.50 [‐1.63, 8.63]

76% vs. 81% (Man 1997)
( n = 100)

LACTATE

Increase in lactate (mmol/L) (systemic)

3 min

1

50

0.98 [0.59, 1.37]*

0.98 [0.59, 1.37]*
(n = 50)

15 min

1

50

0.87 [0.42, 1.32]*

0.87 [0.42, 1.32]*
(n = 50)

30 min

1

50

0.75 [0.29, 1.21]*

0.75 [0.29, 1.21]*
(n = 50)

2 hours

1

50

0.66 [0.17, 1.15]*

0.66 [0.17, 1.15]*
(n = 50)

Increase in lactate (mmol/L) (portal)

3 min

1

50

1.20 [1.09, 1.31]*

1.20 [1.09, 1.31]*
(n = 50)

15 min

1

50

0.73 [0.63, 0.83]*

0.73 [0.63, 0.83]*
(n = 50)

30 min

1

50

0.67 [0.58, 0.76]*

0.67 [0.58, 0.76]*
(n = 50)

ATP

Change in ATP level

Change in median
18 vs 1.6 (Man 1997)
( n = 100)

EVIDENCE OF NEUTROPHIL ACTIVATION

Myeloperioxidase ng/mg of protein if liver tissue (One hour post‐op)

1

50

72.40 [‐33.47, 178.27]

72.40 [‐33.47, 178.27]
(n = 50)

Neutrophil adhesion

No difference in non‐cirrhotic; statistically significant higher levels in HVE in cirrhotics (Clavien 1996)
(n = 15)

ET‐1 (Endothelin 1) expression

increase by 38% vs increase by 28%
(Man 2003)
( n = 40)

IL‐1 (Interleukin 1)

No statistically significant difference between the groups (Clavien 1996)
( n = 15)

IL‐6 (Interleukin 6)

lower in HVE group compared to no occlusion ‐ statistically significant in cirrhotic patients (Clavien 1996)
( n = 15)

TNF‐ (Tumour necrosis factor alpha)

No statistically significant difference between the groups (Clavien 1996)
( n = 15)

CD 18

1

35‐44

No difference at 3,15,30, 120 minutes or 24 hours

PUTATIVE FACTORS

e‐nos (endothelial nitric oxide synthase) expression

increased by 58% vs decreased by 83%* (Man 2003)
( n = 40)

i‐nos (inducible nitric oxide synthase) expression

Overexpressed in the occlusion group (Man 2003)
( n = 40)

OPERATING TIME (min)

1

15

‐52.00 [‐120.28, 16.28]

‐52.00 [‐120.28, 16.28]
N = 15

‐46.80 [‐147.35, 53.75]
(n = 9)

HOSPITAL STAY (days)

2

176

0.23 [‐1.13, 1.59]

‐0.43 [‐4.87, 4.01]
(n = 50)

‐66.00 [‐156.69, 24.69]
(n = 6)

11 vs 10 (Man 1997)
( n = 100)

Notes and abbreviations
ATP = adenosine tri phosphate.
POD = post‐operative day

Some studies could not be included in meta‐analysis as they reported the median or the exact values were not reported. * indicates statistical significance.

Figures and Tables -
Table 3. "Vascular occlusion" versus "No vascular occlusion"
Table 4. Methods of vascular occlusion

Outcome

HVE vs PTC

Chen 2006

PTC:Total vs Select

PTC:Tot vs Sel‐Major

PTC:Tot vs Sel‐Cirrh

PTC:Cont vs Inter

PTC:Cont vs Inter‐Ci

IPTC:30min vs 15 min

ABBREVIATIONS

HVE = Hepatic vascular exclusion
PTC = Portal triad clamping

PTC ‐ inflow occlusion

Tot = Total
Sel = Selective
Major = Major liver resections

Cirrh = Cirrhotic livers

Cont ‐ continuous
Int ‐ intermittent

Ci ‐ Cirrhotic livers

IPTC ‐ intermiitent portal triad clamping

MORTALITY

0.30 [0.03, 2.91]
(n = 170)

Included in meta‐analysis

0.34 [0.01, 8.64]
(n = 138)

0.34 [0.01, 8.64]
(n = 80)

Not estimable
(n = 58)

5.40 [0.61, 47.93]
(n = 121)

5.30 [0.24, 118.89]
(n = 35)

0 vs 0
(n = 92)

MORBIDITY

Liver failure

0.97 [0.13, 7.09]
(n = 170)

Included in meta‐analysis

0.11 [0.01, 2.03]
(n = 80)

0.11 [0.01, 2.03]
(n = 80)

10.40 [0.54, 199.43]
(n = 86)

Ascites

0.68 [0.18, 2.55]
(n = 138)

0.77 [0.16, 3.69]
(n = 80)

0.52 [0.04, 6.06]
(n = 58)

Re‐operation

2.67 [0.10, 68.70]
(n = 52)

Not estimable
(n = 80)

Not estimable
(n = 80)

5.49 [0.26, 117.88]
(n = 86)

Bile leak

1.08 [0.30, 3.83]
(n = 138)

3.23 [0.13, 81.79]
(n = 80)

0.83 [0.20, 3.48]
(n = 58)

0.62 [0.20, 1.99]
(n = 92)

Biliary fistula

1.05 [0.06, 17.33]
(n = 86)

Portal vein thrombosis

0.20 [0.01, 4.30]
(n = 80)

0.20 [0.01, 4.30]
(n = 80)

Intra‐abdominal collections

2.45 [0.72, 8.41]
(n = 170)

Included in meta‐analysis

1.08 [0.30, 3.83] (infected)
(n = 58)

1.08 [0.30, 3.83] (infected)
(n = 58)

0.77 [0.16, 3.66]
(n = 86)

Haematoma

1.77 [0.15, 20.82]
(n = 52)

1.05 [0.06, 17.33]
(n = 86)

Respiratory complications

1.59 [0.72, 3.53]
(n = 170)

Included in meta‐analysis

2.23 [0.19, 26.06]
(n = 58)

2.23 [0.19, 26.06]
(n = 58)

1.05 [0.28, 3.94]
(n = 86)

BLOOD LOSS (ml)

Transection

‐330.00 [‐407.25, ‐252.75]
(n= 118)

Included in meta‐analysis

241.00 [30.05, 451.95]*
(n = 58)

241.00 [30.05, 451.95]*
(n = 58)

‐250.00 [‐387.14, ‐112.86]*
(n = 86)

Operative

‐185.48 [‐682.89, 311.92]
(n = 162)

Included in meta‐analysis

167.43 [‐121.33, 456.19]
(n = 138)

‐64.00 [‐270.76, 142.76]
(n = 80)

526.00 [‐20.73, 1072.73)
(n = 58)

‐58.49 [‐321.68, 204.71]
(n = 121)

1.00 [‐385.35, 387.35]
(n = 35)

352 vs 359
(n = 92)

Number of units transfused

‐0.40 [‐2.58, 1.78]
(n = 44)

0.02 [‐0.40, 0.44]
(n = 80)

0.02 [‐0.40, 0.44]
(n = 80)

0.00 [‐0.70, 0.70]
(n = 35)

0.00 [‐0.70, 0.70]
(n = 35)

Number needing transfusion

0.56 [0.06, 5.66]
(n = 162)

Included in meta‐analysis

1.62 [0.30, 8.81]
(n = 138)

0.67 [0.17, 2.57]
(n = 80)

3.75 [1.11, 12.67]*
(n = 58)

0.88 [0.40, 1.91]
(n = 121)

0.92 [0.21, 4.00]
(n = 35)

1.09 [0.29, 4.10]
(n = 92)

HAEMODYNAMIC CHANGES (during occlusion)

Mean Arterial Pressure (mmHg)

‐5.04 [‐9.69, ‐0.39]*
(n = 162)

Included in meta‐analysis

‐3.40 [‐11.01, 4.21]
(n = 80)

‐3.40 [‐11.01, 4.21]
(n = 80)

Pulmonary Arterial Pressure (mmHg)

‐3.00 [‐5.82, ‐0.18]*
(n = 44)

Cardiac Index (Litre/min/m2)

‐1.10 [‐1.68, ‐0.52]*
(n = 44)

Systemic Vascular resistance (dynes.sec/cm5)

390.00 [146.80, 633.20]*
(n = 44)

Central Venous Pressure (CVP) mmHg

0.10 [‐0.50, 0.70]
(n = 118)

Included in meta‐analysis

‐1.00 [‐2.56, 0.56]
(n = 80)

‐1.00 [‐2.56, 0.56]
(n = 80)

Portal Venous Pressure (PVP) mmHg

19.40 [15.19, 23.61]*
(n = 80)

19.40 [15.19, 23.61]*
(n = 80)

Hepatic Venous Pressure Gradient (HVPG) mmHg (CVP ‐ PVP)

20.60 [16.16, 25.04]*
(n = 80)

20.60 [16.16, 25.04]*
(n = 80)

HAEMODYNAMIC CHANGES (10 min after release of clamp)

Mean Arterial Pressure (mmHg)

‐2.50 [‐9.36, 4.36]
(n = 80)

‐2.50 [‐9.36, 4.36]
(n = 80)

Central Venous Pressure (CVP) mmHg

0.40 [‐1.23, 2.03]
(n = 80)

0.40 [‐1.23, 2.03]
(n = 80)

Portal Venous Pressure (PVP) mmHg

1.10 [‐1.51, 3.71]
(n = 80)

1.10 [‐1.51, 3.71]
(n = 80)

Hepatic Venous Pressure Gradient (HVPG) mmHg (CVP ‐ PVP)

0.30 [‐2.35, 2.95]
(n = 80)

0.30 [‐2.35, 2.95]
(n = 80)

LIVER FUNCTION TESTS

AST (IU/L)

1st POD (post‐operative day)

‐16.00 [‐157.08, 125.08]
(n = 44)

318 [87.28, 548.72]*
(n = 39 cirrhotic livers only)

318 [87.28, 548.72]*
(n = 39 cirrhotic livers only)

318 [87.28, 548.72]*
(n = 39)

30.00 [‐57.48, 117.48]
(n = 86)
340 vs 240
(n = 35)

340 vs 240
(n = 35)

235 vs 274
(n = 92)

2nd POD

134.00 [‐3.59, 271.59]
(n = 86)

3rd POD

76 vs 80
(n = 92)

5th POD

‐1.00 [‐14.01, 12.01]
(n = 44)

8.00 [‐12.62, 28.62]
(n = 86)

7th POD

3.00 [‐6.93, 12.93]
(n = 86)

39 vs 37
(n = 92)

Peak

600 vs 720
n = 118

100 [‐301.71, 501.71]
(n = 58)

100 [‐301.71, 501.71]
(n = 58)

ALT (IU/L)

1st POD

30.00 [‐78.11, 138.11]
(n = 80)

30.00 [‐78.11, 138.11]
(n = 80)

192.00 [52.23, 331.77]
(n = 39)

37.00 [‐81.57, 155.57]
(n = 86)
260 vs 180
(n = 35)

260 vs 180
(n = 35)

255 vs 224
(n = 92)

2nd POD

98.00 [‐40.90, 236.90]
(n = 86)

3rd POD

130 vs 115
(n = 92)

5th POD

16.00 [‐42.82, 74.82]
(n = 86)

7th POD

4.00 [‐32.07, 40.07]
(n = 86)

85 vs 89
(n = 92)

Peak

740 vs 860
(n = 118)

‐120 [‐385.16, 145.16]
(n = 58)

‐120 [‐385.16, 145.16]
(n = 58)

BILIRUBIN (micromole / litre)

1st POD

1.00 [‐7.90, 9.90]
(n = 86)
24 vs 36
(n = 35)

24 vs 36
(n = 35)

2nd POD

2.00 [‐7.10, 11.10]
(n = 86)

5th POD

10.00 [‐4.27, 24.27]
(n = 86)

7th POD

6.00 [‐9.46, 21.46]
(n = 86)

13.7 vs 11.9
(n = 92)

Peak

1.5 vs 1.7
(n = 118)

No difference in peak bilirubin levels
(n = 58)

No difference in peak bilirubin levels
(n = 58)

0.87 [0.42, 1.32]*
(n = 50)

11.1 vs 12.0
(n = 92)

PROTHROMBIN TIME (as percentage of normal function)

1st POD

‐5.00 [‐12.79, 2.79]
(n = 44)

‐2.00 [‐7.92, 3.92]
(n = 86)
72% vs 67%
(n = 35)

72% vs 67%
(n = 35)

2nd POD

1.00 [‐5.76, 7.76]
(n = 86)

5th POD

‐5.00 [‐14.61, 4.61]
(n = 44)

18.00 [11.24, 24.76]
(n = 86)

7th POD

0.00 [‐6.60, 6.60]
(n = 86)

63.9 vs 59.1
(n = 92)

Peak

62.6 vs 63.2
(n = 92)

CREATININE (micromole/litre)

1st POD

10.00 [2.55, 17.45]*
(n = 44)

5th POD

5.00 [‐0.03, 10.03]
(n = 44)

OPERATING TIME (min)

27.95 [‐24.66, 80.57]
(n = 162)

Included in meta‐analysis

‐8.66 [‐27.46, 10.14]
(n = 138)

‐12.00 [‐32.41, 8.41]
(n = 80)

10.00 [‐38.26, 58.26]
(n = 58)

‐13.40 [‐68.08, 41.28]
(n = 35)

‐13.40 [‐68.08, 41.28]
(n = 35)

255 vs 307*
(n = 92)

HOSPITAL STAY (days)

5.00 [‐0.36, 10.36]
(n = 44)

0.34 [‐2.24, 2.92]?
(n = 138)

1.23 [‐0.70, 3.16]
(n = 80)

‐1.60 [‐5.49, 2.29]
(n = 58)

‐1.00 [‐4.82, 2.82]
(n = 86)

12 vs 12
(n = 92)

Figures and Tables -
Table 4. Methods of vascular occlusion
Table 5. Ischaemic preconditioning

Outcome

Number of studies

Number of patients

OR or WMD

Major resections

Non‐cirrhotic livers

Clavien 2003

Meta‐analysis

Smyrniotis 2006

COMPARISON

IPC vs no IPC

IPC vs no IPC

IPC vs no IPC

IPC vs no IPC

IPC vs no IPC

IPC vs no IPC

IPC vs IPTC

IPC vs IPTC

MORTALITY

3

210

5.35 [0.25, 116.31]

5.35 [0.25, 116.31]
(n = 60)

5.35 [0.25, 116.31]
(n = 210)

Included in meta‐analysis

3.17 [0.12, 80.38]
(n = 127)

MORBIDITY

Liver failure

1

60

0.86 [0.29, 2.55]

0.86 [0.29, 2.55]
(n = 60)

0.86 [0.29, 2.55]
(n = 60)

0.19 [0.01, 4.20]
(n = 73)

Encephalopathy

1

60

3.10 [0.12, 79.23]

3.10 [0.12, 79.23]
(n = 60)

3.10 [0.12, 79.23]
(n = 60)

Ascites

1

60

0.51 [0.13, 1.95]

0.51 [0.13, 1.95]
(n = 60)

0.51 [0.13, 1.95]
(n = 60)

Renal insufficiency

1

60

1.00 [0.13, 7.60]

1.00 [0.13, 7.60]
(n = 60)

1.00 [0.13, 7.60]
(n = 60)

Re‐operation

1

60

3.10 [0.12, 79.23]

3.10 [0.12, 79.23]
(n = 60)

3.10 [0.12, 79.23]
(n = 60)

Biliary fistula/ leak

1

60

0.77 [0.19, 3.20]

0.77 [0.19, 3.20]
(n = 60)

0.77 [0.19, 3.20]
(n = 60)

1.47 [0.44, 4.95]
(n = 127)

Included in meta‐analysis

Intra‐abdominal infection

1.03 [0.19, 5.48]
(n = 73)

Infection

1

60

0.62 [0.15, 2.45]

0.62 [0.15, 2.45]
(n = 60)

0.62 [0.15, 2.45]
(n = 60)

0.67 [0.10, 4.25]
(n = 73)

Respiratory complications

1

60

1.00 [0.23, 4.43]

1.00 [0.23, 4.43]
(n = 60)

1.00 [0.23, 4.43]
(n = 60)

0.73 [0.24, 2.23]
(n = 127)

Included in meta‐analysis

BLOOD LOSS (ml)

Transection

‐104.00 [‐230.54, 22.54]
(n = 73)

Operative

2

110

29.49 [‐238.64, 297.62]

‐61.00 [‐466.17, 344.17]
(n = 60)

29.49 [‐238.64, 297.62]
(n = 110)

250 vs 225

‐164.73 [‐271.83, ‐57.64]
(n = 127)

Included in meta‐analysis

Number of units transfused

1

60

‐0.30 [‐1.41, 0.81]

‐0.30 [‐1.41, 0.81]
(n = 60)

‐0.30 [‐1.41, 0.81]
(n = 60)

‐1.20 [‐2.33, ‐0.07]
(n = 73)

0 vs 0
(n = 54)

Number needing transfusion

1

50

0.18 [0.01, 4.04]

0.18 [0.01, 4.04]
(n = 60)

0.79 [0.28, 2.21]
(n = 73)

HAEMODYNAMIC CHANGES (during occlusion)

Mean Arterial Pressure (mmHg)

1

8

‐2.80 [‐22.07, 16.47]

‐2.80 [‐22.07, 16.47]
(n = 8)

Cardiac Index (Litre/min/m2)

1

8

‐0.15 [‐1.35, 1.05]

‐0.15 [‐1.35, 1.05]
(n = 8)

Stroke Volume (ml/ m2)

1

8

‐33.00 [‐357.88, 291.88]

‐33.00 [‐357.88, 291.88]
(n = 8)

Systemic Vascular resistance Index (dynes.sec. 104/cm3)

1

8

9.50 [‐3.25, 22.25]

9.50 [‐3.25, 22.25]
(n = 8)

LIVER FUNCTION TESTS

AST (IU/L)

1st POD (post‐operative day)

1

50

‐193.60 [‐398.41, 11.21]

‐193.60 [‐398.41, 11.21]
(n = 50)

14.00 [‐87.19, 115.19]
(n = 54)

Included in meta‐analysis

2nd POD

1

50

‐141.00 [‐276.01, ‐5.99]*

‐141.00 [‐276.01, ‐5.99]*
(n = 50)

3rd POD

66.00 [4.69, 127.31]*
(n = 54)

Included in meta‐analysis

6th POD

‐2.00 [‐7.07, 3.07]
(n = 54)

Included in meta‐analysis

7th POD

1

60

‐0.10 [‐17.63, 17.43]

‐0.10 [‐17.63, 17.43]
(n = 60)

‐0.10 [‐17.63, 17.43]
(n = 60)

Peak level

1

60

424.00 [‐213.22, 1061.22]

424.00 [‐213.22, 1061.22]
(n = 60)

424.00 [‐213.22, 1061.22]
(n = 60)

364 vs. 520*

117.00 [‐66.53, 300.53]
(n = 73)

On discharge

1

60

‐1.80 [‐24.74, 21.14]

‐1.80 [‐24.74, 21.14]
(n = 60)

‐1.80 [‐24.74, 21.14]
(n = 60)

Day 30

1

60

‐7.30 [‐33.57, 18.97]

‐7.30 [‐33.57, 18.97]
(n = 60)

‐7.30 [‐33.57, 18.97]
(n = 60)

LIVER FUNCTION TESTS

ALT (IU/L)

1st POD

1

50

‐258.00 [‐453.54, ‐62.46]*

‐258.00 [‐453.54, ‐62.46]*
(n = 50)

2nd POD

1

50

‐288.50 [‐581.56, 4.56]

‐288.50 [‐581.56, 4.56]
(n = 50)

7th POD

1

60

25.70 [‐6.63, 58.03]

25.70 [‐6.63, 58.03]
(n = 60)

25.70 [‐6.63, 58.03]
(n = 60)

Peak level

1

60

314.00 [‐49.17, 677.17]

314.00 [‐49.17, 677.17]
(n = 60)

314.00 [‐49.17, 677.17]
(n = 60)

406 vs. 519*

‐108.00 [‐277.77, 61.77]
(n = 73)

On discharge

1

60

3.80 [‐25.24, 32.84]

3.80 [‐25.24, 32.84]
(n = 60)

3.80 [‐25.24, 32.84]
(n = 60)

Day 30

1

60

4.40 [‐15.26, 24.06]

4.40 [‐15.26, 24.06]
(n = 60)

4.40 [‐15.26, 24.06]
(n = 60)

Alpha‐glutathione‐S‐transferase (IU/L)

7th POD

1

60

‐2.00 [‐4.18, 0.18]

‐2.00 [‐4.18, 0.18]
(n = 60)

‐2.00 [‐4.18, 0.18]
(n = 60)

Peak level

1

60

116.00 [10.09, 221.91]*

116.00 [10.09, 221.91]*
(n = 60)

116.00 [10.09, 221.91]*
(n = 60)

Lower* in IPC (Chouker 2005)(Chouker 2005)

Bilirubin (micromole / litre)

1st POD

1.00 [‐3.40, 5.40]
(n = 54)

Included in meta‐analysis

3rd POD

0.50 [‐3.76, 4.76]
(n = 54)

Included in meta‐analysis

6th POD

3.80 [‐0.10, 7.70]
(n = 54)

Included in meta‐analysis

7th POD

1

60

‐11.00 [‐45.20, 23.20]

‐11.00 [‐45.20, 23.20]
(n = 60)

‐11.00 [‐45.20, 23.20]
(n = 60)

Peak level

1

60

‐18.20 [‐51.46, 15.06]

‐18.20 [‐51.46, 15.06]
(n = 60)

‐18.20 [‐51.46, 15.06]
(n = 60)

46 vs. 56

1.80 [‐27.74, 31.34]
(n = 73)

On discharge

1

60

‐2.90 [‐17.54, 11.74]

‐2.90 [‐17.54, 11.74]
(n = 60)

‐2.90 [‐17.54, 11.74]
(n = 60)

Day 30

1

60

0.60 [‐28.31, 29.51]

0.60 [‐28.31, 29.51]
(n = 60)

0.60 [‐28.31, 29.51]
(n = 60)

Prothrombin time (as percentage of normal function)

1st POD

0.90 [‐2.54, 4.34]
(n = 54)

Included in meta‐analysis

3rd POD

0.10 [‐2.84, 3.04]
(n = 54)

Included in meta‐analysis

6th POD

‐2.30 [‐5.58, 0.98]
(n = 54)

Included in meta‐analysis

7th POD

1

50

3.00 [‐4.24, 10.24]

3.00 [‐4.24, 10.24]
(n = 60)

3.00 [‐4.24, 10.24]
(n = 60)

Nadir level

1

60

3.80 [‐1.98, 9.58]

3.80 [‐1.98, 9.58]
(n = 60)

3.80 [‐1.98, 9.58]
(n = 60)

76% vs. 81%

1.90 [‐6.28, 10.08]
(n = 73)

On discharge

1

60

2.00 [‐5.29, 9.29]

2.00 [‐5.29, 9.29]
(n = 60)

2.00 [‐5.29, 9.29]
(n = 60)

Day 30

1

60

1.30 [‐7.10, 9.70]

1.30 [‐7.10, 9.70]
(n = 60)

1.30 [‐7.10, 9.70]
(n = 60)

CREATININE (micromoles/litre)

Peak level

1

100

‐64.00 [‐83.79, ‐44.21]*

‐64.00 [‐83.79, ‐44.21]*
(n = 100)

‐64.00 [‐83.79, ‐44.21]*
(n = 100)

LACTATE

Increase in lactate (mmol/L) (systemic)

3 min

1

50

‐0.45 [‐0.53, ‐0.37]*

‐0.45 [‐0.53, ‐0.37]*
(n = 50)

15 min

1

50

‐0.60 [‐0.69, ‐0.51]*

‐0.60 [‐0.69, ‐0.51]*
(n = 50)

30 min

1

50

‐0.47 [‐5.96, 5.02]

‐0.47 [‐5.96, 5.02]
(n = 50)

2 hours

1

50

‐0.66 [‐0.76, ‐0.56]*

‐0.66 [‐0.76, ‐0.56]*
(n = 50)

Increase in lactate (mmol/L) (portal)

3 min

1

50

‐0.68 [‐0.79, ‐0.57]*

‐0.68 [‐0.79, ‐0.57]*
(n = 50)

15 min

1

50

‐0.44 [‐0.53, ‐0.35]*

‐0.44 [‐0.53, ‐0.35]*
(n = 50)

30 min

1

50

‐0.50 [‐0.61, ‐0.39]*

‐0.50 [‐0.61, ‐0.39]*
(n = 50)

ATP

Increased in IPC* in young but decreased in IPC in old

PURINES

Change in portal venous‐arterial inosine gradient

1

32

No difference at 3 or 15 minutes

Change in portal venous‐arterial hypoxanthine gradient

1

32

No difference at 3 or 15 minutes

Change in portal venous‐arterial hypoxanthine gradient

1

32

No difference at 3 or 15 minutes

NEUTROPHIL ACTIVATION

Increase in myeloperoxidase activity (ng/mg of total protein of liver tissue) (One hour post‐op)

1

50

52.10 [22.99, 81.21]*

52.10 [22.99, 81.21]*
(n = 50)

CD 18

1

35‐44

No difference at 3,15,30, 120 minutes or 24 hours

APOPTOSIS

Caspase‐3

‐0.90 [‐3.33, 1.53]
(n = 54)

Included in meta‐analysis

Apoptotic bodies

3.00 [0.22, 5.78]
(n = 54)

Included in meta‐analysis

OPERATING TIME

‐13.82 [‐51.17, 23.54]
(n = 127)

Included in meta‐analysis

STAY

ITU stay

2

109

‐1.71 [‐2.23, ‐1.20]*

‐0.90 [‐2.47, 0.67]
(n = 60)

‐1.67 [‐2.32, ‐1.02]*
(n = 109)

2.20 [‐0.34, 4.74]
(n = 73)

0 vs 0 (median)
(n = 54)

Hospital stay

2

109

‐1.88 [‐2.58, ‐1.19]*

‐3.10 [‐7.30, 1.10]
(n = 60)

‐1.88 [‐2.58, ‐1.19]*
(n = 109)

‐0.10 [‐2.79, 2.60]
(n = 127)

Included in meta‐analysis

Figures and Tables -
Table 5. Ischaemic preconditioning
Comparison 1. Vascular occlusion versus 'no vascular occlusion'

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

5

331

Odds Ratio (M‐H, Fixed, 95% CI)

0.55 [0.11, 2.61]

2 Liver failure Show forest plot

1

126

Odds Ratio (M‐H, Fixed, 95% CI)

0.48 [0.09, 2.74]

3 Other Morbidity Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Abdominal collection

1

126

Odds Ratio (M‐H, Fixed, 95% CI)

1.19 [0.38, 3.75]

3.2 Bleeding

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

3.06 [0.12, 76.95]

3.3 Biliary fistula

2

226

Odds Ratio (M‐H, Fixed, 95% CI)

1.53 [0.42, 5.62]

3.4 Wound infection

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.16, 3.46]

3.5 Uraemia

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.21]

3.6 Pulmonary

2

226

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.47, 1.87]

4 Blood loss Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Transection

2

176

Mean Difference (IV, Random, 95% CI)

‐328.04 [‐973.40, 317.31]

4.2 Operative

1

50

Mean Difference (IV, Random, 95% CI)

‐788.00 [‐1223.54, ‐356.46]

5 Number needing transfusion Show forest plot

5

331

Odds Ratio (M‐H, Random, 95% CI)

0.38 [0.10, 1.46]

6 Number of units transfused Show forest plot

2

141

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.44, 0.24]

7 Haemodynamic Changes (10 min) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Mean Arterial Pressure (mm Hg)

1

8

Mean Difference (IV, Fixed, 95% CI)

12.1 [‐4.57, 28.77]

7.2 Cardiac Index Litre/min/ sq m

1

8

Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐1.47, 1.17]

7.3 Stroke volume index (ml/ sq m)

1

8

Mean Difference (IV, Fixed, 95% CI)

194.00 [‐94.17, 482.17]

7.4 Systemic Vascular Resistance Index (dynes. sec 10^4 / cu cm)

1

8

Mean Difference (IV, Fixed, 95% CI)

‐7.20 [‐22.06, 7.66]

8 AST (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 First post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

254.0 [43.41, 464.59]

8.2 Second post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

158.0 [20.38, 295.62]

8.3 Third post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

14.30 [‐12.43, 41.03]

8.4 Seventh post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

3.5 [‐31.61, 38.61]

9 ALT (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 First post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

265.10 [48.84, 481.36]

9.2 Second post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

301.2 [‐2.48, 604.88]

9.3 Third post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

46.0 [‐12.24, 104.24]

9.4 Seventh post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

10.40 [‐30.12, 50.92]

10 Bilirubin (micromole/litre) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 Third post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.69, 0.29]

10.2 Seventh post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐0.79, 0.19]

11 Prothrombin time (percentage of normal) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

11.1 Third post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

2.10 [‐2.22, 6.42]

11.2 Seventh post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

3.5 [‐1.63, 8.63]

12 Increase in lactate (mmol/L) (Systemic) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

12.1 3 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.98 [0.59, 1.37]

12.2 15 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.87 [0.42, 1.32]

12.3 30 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.75 [0.29, 1.21]

12.4 2 hours

1

50

Mean Difference (IV, Fixed, 95% CI)

0.66 [0.17, 1.15]

13 Increase in lactate (mmol/L) (Portal) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

13.1 3 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

1.2 [1.09, 1.31]

13.2 15 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.73 [0.63, 0.83]

13.3 30 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.67 [0.58, 0.76]

14 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue) Show forest plot

1

50

Mean Difference (IV, Fixed, 95% CI)

72.4 [‐33.47, 178.27]

15 CD18 (Relative fluorescence units) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

15.1 3 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.2 15 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.3 30 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.4 2 hours

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.5 24 hours

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

16 Inosine (Portal vein ‐ arterial) nmol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

16.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

208.0 [‐327.93, 743.93]

16.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

5.9 [‐11.17, 22.97]

17 Hypoxanthine (Portal vein ‐ arterial) micromol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

17.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

1.08 [0.34, 1.82]

17.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

0.05 [‐1.03, 1.13]

18 Xanthine (Portal vein ‐ arterial) micromol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

18.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

0.06 [‐0.06, 0.18]

18.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

‐1.43 [‐2.96, 0.10]

19 Operating time (in minutes) Show forest plot

1

15

Mean Difference (IV, Fixed, 95% CI)

‐50.00 [‐120.28, 16.28]

20 Hospital Stay (in days) Show forest plot

2

176

Mean Difference (IV, Fixed, 95% CI)

0.23 [‐1.13, 1.59]

Figures and Tables -
Comparison 1. Vascular occlusion versus 'no vascular occlusion'
Comparison 2. Vascular occlusion versus 'no vascular occlusion' (Major resections)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

15

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number needing transfusion Show forest plot

1

15

Odds Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.24]

3 Number of units transfused Show forest plot

1

15

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐3.20, 2.00]

4 Operating time (in minutes) Show forest plot

1

15

Mean Difference (IV, Fixed, 95% CI)

‐50.00 [‐120.28, 16.28]

Figures and Tables -
Comparison 2. Vascular occlusion versus 'no vascular occlusion' (Major resections)
Comparison 3. Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

2

59

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Blood loss Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Transection

1

50

Mean Difference (IV, Fixed, 95% CI)

‐680.0 [‐1022.34, ‐337.66]

2.2 Operative

1

50

Mean Difference (IV, Fixed, 95% CI)

‐788.00 [‐1223.54, ‐356.46]

3 Number needing transfusion Show forest plot

2

59

Odds Ratio (M‐H, Fixed, 95% CI)

0.15 [0.04, 0.63]

4 Number of units transfused Show forest plot

1

9

Mean Difference (IV, Fixed, 95% CI)

0.00 [‐5.69, 1.69]

5 Haemodynamic Changes (10 min) Show forest plot

1

32

Mean Difference (IV, Fixed, 95% CI)

‐0.13 [‐1.43, 1.18]

5.1 Mean Arterial Pressure (mm Hg)

1

8

Mean Difference (IV, Fixed, 95% CI)

12.1 [‐4.57, 28.77]

5.2 Cardiac Index Litre/min/ sq m

1

8

Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐1.47, 1.17]

5.3 Stroke volume index (ml/ sq m)

1

8

Mean Difference (IV, Fixed, 95% CI)

194.00 [‐94.17, 482.17]

5.4 Systemic Vascular Resistance Index (dynes. sec 10^4 / cu cm)

1

8

Mean Difference (IV, Fixed, 95% CI)

‐7.20 [‐22.06, 7.66]

6 AST (IU/L) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 First post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

254.0 [43.41, 464.59]

6.2 Second post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

158.0 [20.38, 295.62]

7 ALT (IU/L) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 First post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

265.10 [48.84, 481.36]

7.2 Second post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

301.2 [‐2.48, 604.88]

8 Increase in lactate (mmol/L) (Systemic) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 3 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.98 [0.59, 1.37]

8.2 15 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.87 [0.42, 1.32]

8.3 30 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.75 [0.29, 1.21]

8.4 2 hours

1

50

Mean Difference (IV, Fixed, 95% CI)

0.66 [0.17, 1.15]

9 Increase in lactate (mmol/L) (Portal) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 3 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

1.2 [1.09, 1.31]

9.2 15 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.73 [0.63, 0.83]

9.3 30 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.67 [0.58, 0.76]

10 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue) Show forest plot

1

50

Mean Difference (IV, Fixed, 95% CI)

72.4 [‐33.47, 178.27]

11 CD18 (Relative fluorescence units) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

11.1 3 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 15 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.3 30 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.4 2 hours

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.5 24 hours

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Inosine (Portal vein ‐ arterial) nmol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

12.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

208.0 [‐327.93, 743.93]

12.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

5.9 [‐11.17, 22.97]

13 Hypoxanthine (Portal vein ‐ arterial) micromol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

13.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

1.08 [0.34, 1.82]

13.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

0.05 [‐1.03, 1.13]

14 Xanthine (Portal vein ‐ arterial) micromol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

14.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

0.06 [‐0.06, 0.18]

14.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

‐1.43 [‐2.96, 0.10]

15 Operating time (in minutes) Show forest plot

1

9

Mean Difference (IV, Fixed, 95% CI)

‐46.80 [‐147.35, 53.75]

16 Hospital Stay (in days) Show forest plot

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.43 [‐4.87, 4.01]

Figures and Tables -
Comparison 3. Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic)
Comparison 4. Vascular occlusion versus 'no vascular occlusion' (Cirrhotic)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

6

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number needing transfusion Show forest plot

1

6

Odds Ratio (M‐H, Fixed, 95% CI)

0.25 [0.01, 7.45]

3 Number of units transfused Show forest plot

1

6

Mean Difference (IV, Fixed, 95% CI)

1.3 [‐2.72, 5.32]

4 Operating time (in minutes) Show forest plot

1

6

Mean Difference (IV, Fixed, 95% CI)

‐66.0 [‐156.69, 24.69]

Figures and Tables -
Comparison 4. Vascular occlusion versus 'no vascular occlusion' (Cirrhotic)
Comparison 5. Intermittent vascular occlusion versus 'no vascular occlusion'

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

4

316

Odds Ratio (M‐H, Fixed, 95% CI)

0.55 [0.11, 2.61]

2 Liver failure Show forest plot

1

126

Odds Ratio (M‐H, Fixed, 95% CI)

0.48 [0.09, 2.74]

3 Other Morbidity Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Abdominal collection

1

126

Odds Ratio (M‐H, Fixed, 95% CI)

1.19 [0.38, 3.75]

3.2 Bleeding

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

3.06 [0.12, 76.95]

3.3 Biliary fistula

2

226

Odds Ratio (M‐H, Fixed, 95% CI)

1.53 [0.42, 5.62]

3.4 Wound infection

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.16, 3.46]

3.5 Uraemia

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.21]

3.6 Pulmonary

2

226

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.47, 1.87]

4 Blood loss Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Transection

2

176

Mean Difference (IV, Random, 95% CI)

‐328.04 [‐973.40, 317.31]

4.2 Operative

1

50

Mean Difference (IV, Random, 95% CI)

‐788.00 [‐1223.54, ‐356.46]

5 Number needing transfusion Show forest plot

4

316

Odds Ratio (M‐H, Random, 95% CI)

0.42 [0.08, 2.17]

6 Number of units transfused Show forest plot

1

126

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.49, 0.29]

7 Haemodynamic Changes (10 min) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Mean Arterial Pressure (mm Hg)

1

8

Mean Difference (IV, Fixed, 95% CI)

12.1 [‐4.57, 28.77]

7.2 Cardiac Index Litre/min/ sq m

1

8

Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐1.47, 1.17]

7.3 Stroke volume index (ml/ sq m)

1

8

Mean Difference (IV, Fixed, 95% CI)

194.00 [‐94.17, 482.17]

7.4 Systemic Vascular Resistance Index (dynes. sec 10^4 / cu cm)

1

8

Mean Difference (IV, Fixed, 95% CI)

‐7.20 [‐22.06, 7.66]

8 AST (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 First post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

254.0 [43.41, 464.59]

8.2 Second post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

158.0 [20.38, 295.62]

8.3 Third post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

14.30 [‐12.43, 41.03]

8.4 Seventh post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

3.5 [‐31.61, 38.61]

9 ALT (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 First post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

265.10 [48.84, 481.36]

9.2 Second post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

301.2 [‐2.48, 604.88]

9.3 Third post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

46.0 [‐12.24, 104.24]

9.4 Seventh post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

10.40 [‐30.12, 50.92]

10 Bilirubin (micromole/litre) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 Third post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.69, 0.29]

10.2 Seventh post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐0.79, 0.19]

11 Prothrombin time (percentage of normal) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

11.1 Third post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

2.10 [‐2.22, 6.42]

11.2 Seventh post‐operative day

1

126

Mean Difference (IV, Fixed, 95% CI)

3.5 [‐1.63, 8.63]

12 Increase in lactate (mmol/L) (Systemic) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

12.1 3 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.98 [0.59, 1.37]

12.2 15 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.87 [0.42, 1.32]

12.3 30 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.75 [0.29, 1.21]

12.4 2 hours

1

50

Mean Difference (IV, Fixed, 95% CI)

0.66 [0.17, 1.15]

13 Increase in lactate (mmol/L) (Portal) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

13.1 3 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

1.2 [1.09, 1.31]

13.2 15 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.73 [0.63, 0.83]

13.3 30 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

0.67 [0.58, 0.76]

14 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue) Show forest plot

1

50

Mean Difference (IV, Fixed, 95% CI)

72.4 [‐33.47, 178.27]

15 CD18 (Relative fluorescence units) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

15.1 3 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.2 15 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.3 30 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.4 2 hours

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.5 24 hours

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

16 Inosine (Portal vein ‐ arterial) nmol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

16.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

208.0 [‐327.93, 743.93]

16.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

5.9 [‐11.17, 22.97]

17 Hypoxanthine (Portal vein ‐ arterial) micromol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

17.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

1.08 [0.34, 1.82]

17.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

0.05 [‐1.03, 1.13]

18 Xanthine (Portal vein ‐ arterial) micromol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

18.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

0.06 [‐0.06, 0.18]

18.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

‐1.43 [‐2.96, 0.10]

19 Hospital Stay (in days) Show forest plot

2

176

Mean Difference (IV, Fixed, 95% CI)

0.23 [‐1.13, 1.59]

Figures and Tables -
Comparison 5. Intermittent vascular occlusion versus 'no vascular occlusion'
Comparison 6. Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

2

170

Odds Ratio (M‐H, Fixed, 95% CI)

0.30 [0.03, 2.91]

2 Liver failure Show forest plot

2

170

Odds Ratio (M‐H, Fixed, 95% CI)

0.97 [0.13, 7.09]

3 Peri‐operative Morbidity Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Re‐operation

1

52

Odds Ratio (M‐H, Fixed, 95% CI)

2.67 [0.10, 68.70]

3.2 Intra‐abdominal collections

2

170

Odds Ratio (M‐H, Fixed, 95% CI)

2.45 [0.72, 8.41]

3.3 Ascites

1

118

Odds Ratio (M‐H, Fixed, 95% CI)

0.62 [0.17, 2.32]

3.4 Haematoma

1

52

Odds Ratio (M‐H, Fixed, 95% CI)

1.77 [0.15, 20.82]

3.5 Respiratory complications

2

170

Odds Ratio (M‐H, Fixed, 95% CI)

1.59 [0.72, 3.53]

3.6 Air embolism

1

44

Odds Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 3.34]

4 Blood loss (ml) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Transection blood loss

1

118

Mean Difference (IV, Random, 95% CI)

‐330.0 [‐407.25, ‐252.75]

4.2 Operative blood loss

2

162

Mean Difference (IV, Random, 95% CI)

‐185.48 [‐682.89, 311.92]

5 Number of units transfused Show forest plot

1

44

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐2.58, 1.78]

6 Number needing transfusion Show forest plot

2

170

Odds Ratio (M‐H, Random, 95% CI)

0.56 [0.06, 5.66]

7 Haemodynamic Changes Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Mean Arterial Pressure (MAP) mmHg

2

162

Mean Difference (IV, Fixed, 95% CI)

‐5.04 [‐9.69, ‐0.39]

7.2 Pulmonary Arterial Pressure (PAP) mmHg

1

44

Mean Difference (IV, Fixed, 95% CI)

‐3.0 [‐5.82, ‐0.18]

7.3 Cardiac Index (L/ min/ sq. m)

1

44

Mean Difference (IV, Fixed, 95% CI)

‐1.1 [‐1.68, ‐0.52]

7.4 Systemic Vascular Resistance (SVR) dyne.s.cm^‐5

1

44

Mean Difference (IV, Fixed, 95% CI)

390.0 [146.80, 633.20]

7.5 CVP (cm water)

1

118

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.50, 0.70]

8 AST (IU/L) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 First post‐operative day

1

44

Mean Difference (IV, Fixed, 95% CI)

‐16.0 [‐157.08, 125.08]

8.2 Fifth post‐operative day

1

44

Mean Difference (IV, Fixed, 95% CI)

‐1.0 [‐14.01, 12.01]

9 Prothrombin time (percentage of normal) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 First post‐operative day

1

44

Mean Difference (IV, Fixed, 95% CI)

‐5.0 [‐12.79, 2.79]

9.2 Fifth post‐operative day

1

40

Mean Difference (IV, Fixed, 95% CI)

‐5.0 [‐14.61, 4.61]

10 Creatinine (micromole/litre) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 First post‐operative day

1

44

Mean Difference (IV, Fixed, 95% CI)

10.0 [2.55, 17.45]

10.2 Fifth post‐operative day

1

44

Mean Difference (IV, Fixed, 95% CI)

5.0 [‐0.03, 10.03]

11 Operating Time (minutes) Show forest plot

2

162

Mean Difference (IV, Random, 95% CI)

27.95 [‐24.66, 80.57]

12 Hospital Stay (days) Show forest plot

1

44

Mean Difference (IV, Fixed, 95% CI)

5.0 [‐0.36, 10.36]

Figures and Tables -
Comparison 6. Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC)
Comparison 7. Inflow occlusion: 'total' versus 'selective'

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

2

138

Odds Ratio (M‐H, Fixed, 95% CI)

0.34 [0.01, 8.64]

2 Liver failure Show forest plot

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 2.03]

3 Other Morbidity Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Portal vein thrombosis

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.30]

3.2 Ascites

2

138

Odds Ratio (M‐H, Fixed, 95% CI)

0.68 [0.18, 2.55]

3.3 Re‐operation

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.4 Bile leak

2

138

Odds Ratio (M‐H, Fixed, 95% CI)

1.08 [0.30, 3.83]

3.5 Intra‐abdominal abscesses

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

0.6 [0.13, 2.78]

3.6 Wound infection

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.35]

3.7 Respiratory complications

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

2.23 [0.19, 26.06]

4 Blood loss (ml) Show forest plot

2

196

Mean Difference (IV, Random, 95% CI)

167.43 [‐121.33, 456.19]

4.1 Transection

1

58

Mean Difference (IV, Random, 95% CI)

241.0 [30.05, 451.95]

4.2 Operative

2

138

Mean Difference (IV, Random, 95% CI)

174.49 [‐392.99, 741.97]

5 Number of units transfused Show forest plot

1

80

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.40, 0.44]

6 Number needing Transfusion Show forest plot

2

138

Odds Ratio (M‐H, Random, 95% CI)

1.62 [0.30, 8.81]

7 Hemodynamics change (10 min after clamping) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Central Venous Pressure (CVP) mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

1.00 [‐2.56, 0.56]

7.2 Portal Pressure (PP) mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

19.4 [15.19, 23.61]

7.3 Hepatic Venous Pressure Gradient (HVPG) mmHg (CVP‐PP)

1

80

Mean Difference (IV, Fixed, 95% CI)

20.60 [16.16, 25.04]

7.4 Mean Arterial Pressure mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

‐3.40 [‐11.01, 4.21]

8 Hemodynamics change (10 min after release of clamping) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 Central Venous Pressure (CVP) mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐1.23, 2.03]

8.2 Portal Pressure (PP) mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

1.1 [‐1.51, 3.71]

8.3 Hepatic Venous Pressure Gradient (HVPG) mmHg (CVP‐PP)

1

80

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐2.35, 2.95]

8.4 Mean Arterial Pressure mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

‐2.5 [‐9.36, 4.36]

9 AST (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 First post‐operative day

1

39

Mean Difference (IV, Fixed, 95% CI)

318.0 [87.28, 548.72]

9.2 Peak

1

58

Mean Difference (IV, Fixed, 95% CI)

100.0 [‐301.71, 501.71]

10 ALT (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 First post‐operative day

1

80

Mean Difference (IV, Fixed, 95% CI)

30.00 [‐78.11, 138.11]

10.2 Peak

1

58

Mean Difference (IV, Fixed, 95% CI)

‐120.0 [‐385.16, 145.16]

11 Operating time (min) Show forest plot

2

138

Mean Difference (IV, Fixed, 95% CI)

‐8.66 [‐27.46, 10.14]

12 Hospital Stay (in days) Show forest plot

2

138

Mean Difference (IV, Random, 95% CI)

0.34 [‐2.24, 2.92]

Figures and Tables -
Comparison 7. Inflow occlusion: 'total' versus 'selective'
Comparison 8. Inflow occlusion: 'total' versus 'selective' (Minor resections)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.34 [0.01, 8.64]

2 Liver failure Show forest plot

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 2.03]

3 Other Morbidity Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Portal vein thrombosis

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.30]

3.2 Ascites

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.77 [0.16, 3.69]

3.3 Re‐operation

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.4 Bile leak

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

3.23 [0.13, 81.79]

4 Blood loss (ml) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 Operative

1

80

Mean Difference (IV, Fixed, 95% CI)

‐64.0 [‐270.76, 142.76]

5 Number of units transfused Show forest plot

1

80

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.40, 0.44]

6 Number needing Transfusion Show forest plot

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.67 [0.17, 2.57]

7 Hemodynamics change (10 min after clamping) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Central Venous Pressure (CVP) mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

1.00 [‐2.56, 0.56]

7.2 Portal Pressure (PP) mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

19.4 [15.19, 23.61]

7.3 Hepatic Venous Pressure Gradient (HVPG) mmHg (CVP‐PP)

1

80

Mean Difference (IV, Fixed, 95% CI)

20.60 [16.16, 25.04]

7.4 Mean Arterial Pressure mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

‐3.40 [‐11.01, 4.21]

8 Hemodynamics change (10 min after release of clamping) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 Central Venous Pressure (CVP) mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐1.23, 2.03]

8.2 Portal Pressure (PP) mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

1.1 [‐1.51, 3.71]

8.3 Hepatic Venous Pressure Gradient (HVPG) mmHg (CVP‐PP)

1

80

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐2.35, 2.95]

8.4 Mean Arterial Pressure mmHg

1

80

Mean Difference (IV, Fixed, 95% CI)

‐2.5 [‐9.36, 4.36]

9 AST (IU/L) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 First post‐operative day

1

39

Mean Difference (IV, Fixed, 95% CI)

318.0 [87.28, 548.72]

10 ALT (IU/L) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 First post‐operative day

1

80

Mean Difference (IV, Fixed, 95% CI)

30.00 [‐78.11, 138.11]

11 Operating time (min) Show forest plot

1

80

Mean Difference (IV, Fixed, 95% CI)

‐12.0 [‐32.41, 8.41]

12 Hospital Stay (in days) Show forest plot

1

80

Mean Difference (IV, Fixed, 95% CI)

1.23 [‐0.70, 3.16]

Figures and Tables -
Comparison 8. Inflow occlusion: 'total' versus 'selective' (Minor resections)
Comparison 9. Inflow occlusion: 'total' versus 'selective' (Cirrhotic)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Other Morbidity Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Ascites

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

0.52 [0.04, 6.06]

2.2 Bile leak

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.20, 3.48]

2.3 Intra‐abdominal abscesses

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

0.6 [0.13, 2.78]

2.4 Wound infection

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 4.35]

2.5 Respiratory complications

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

2.23 [0.19, 26.06]

3 Blood loss (ml) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 Transection

1

58

Mean Difference (IV, Random, 95% CI)

241.0 [30.05, 451.95]

3.2 Operative

1

58

Mean Difference (IV, Random, 95% CI)

526.0 [‐20.73, 1072.73]

4 Number needing Transfusion Show forest plot

1

58

Odds Ratio (M‐H, Fixed, 95% CI)

3.75 [1.11, 12.67]

5 AST (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 First post‐operative day

1

39

Mean Difference (IV, Fixed, 95% CI)

318.0 [87.28, 548.72]

5.2 Peak

1

58

Mean Difference (IV, Fixed, 95% CI)

100.0 [‐301.71, 501.71]

6 ALT (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 First post‐operative day

1

39

Mean Difference (IV, Fixed, 95% CI)

192.00 [52.23, 331.77]

6.2 Peak

1

58

Mean Difference (IV, Fixed, 95% CI)

‐120.0 [‐385.16, 145.16]

7 Operating time (min) Show forest plot

1

58

Mean Difference (IV, Fixed, 95% CI)

10.0 [‐38.26, 58.26]

8 Hospital Stay (in days) Show forest plot

1

58

Mean Difference (IV, Fixed, 95% CI)

‐1.60 [‐5.49, 2.29]

Figures and Tables -
Comparison 9. Inflow occlusion: 'total' versus 'selective' (Cirrhotic)
Comparison 10. Portal triad clamping: 'continuous' versus 'intermittent'

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

2

121

Odds Ratio (M‐H, Fixed, 95% CI)

5.40 [0.61, 47.93]

2 Liver failure Show forest plot

1

86

Odds Ratio (M‐H, Fixed, 95% CI)

10.40 [0.54, 199.43]

3 Other Morbidity Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Abdominal collection

1

86

Odds Ratio (M‐H, Fixed, 95% CI)

0.77 [0.16, 3.66]

3.2 Haematoma

1

86

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.06, 17.33]

3.3 Biliary fistula

1

86

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.06, 17.33]

3.4 Re‐operation

1

86

Odds Ratio (M‐H, Fixed, 95% CI)

5.49 [0.26, 117.88]

3.5 Pulmonary

1

86

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.28, 3.94]

4 Blood loss Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 Transection

1

86

Mean Difference (IV, Fixed, 95% CI)

‐248.00 [‐387.14, ‐112.86]

4.2 Operative

2

121

Mean Difference (IV, Fixed, 95% CI)

‐58.49 [‐321.68, 204.71]

5 Number needing transfusion Show forest plot

2

121

Odds Ratio (M‐H, Fixed, 95% CI)

0.88 [0.40, 1.91]

6 Number of units transfused Show forest plot

1

35

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.70, 0.70]

7 AST (IU/L) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 First post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

30.0 [‐57.48, 117.48]

7.2 Second post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

134.0 [‐3.59, 271.59]

7.3 Fifth post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

8.0 [‐12.62, 28.62]

7.4 Seventh post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

3.0 [‐6.93, 12.93]

8 ALT (IU/L) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 First post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

37.0 [‐81.57, 155.57]

8.2 Second post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

98.0 [‐40.90, 236.90]

8.3 Fifth post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

16.0 [‐42.82, 74.82]

8.4 Seventh post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

4.0 [‐32.07, 40.07]

9 Bilirubin (micromole/litre) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 First post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐7.90, 9.90]

9.2 Second post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

2.0 [‐7.10, 11.10]

9.3 Fifth post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

10.0 [‐4.27, 24.27]

9.4 Seventh post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

6.0 [‐9.46, 21.46]

10 Prothrombin time (percentage of normal) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 First post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐7.92, 3.92]

10.2 Second post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐5.76, 7.76]

10.3 Fifth post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

18.0 [11.24, 24.76]

10.4 Seventh post‐operative day

1

86

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐6.60, 6.60]

11 Operating time (in minutes) Show forest plot

1

35

Mean Difference (IV, Fixed, 95% CI)

‐13.40 [‐68.08, 41.28]

12 Hospital Stay (in days) Show forest plot

1

86

Mean Difference (IV, Fixed, 95% CI)

‐1.0 [‐4.82, 2.82]

Figures and Tables -
Comparison 10. Portal triad clamping: 'continuous' versus 'intermittent'
Comparison 11. Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

35

Odds Ratio (M‐H, Fixed, 95% CI)

5.30 [0.24, 118.89]

2 Blood loss Show forest plot

1

35

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐385.35, 387.35]

2.1 Operative

1

35

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐385.35, 387.35]

3 Number needing transfusion Show forest plot

1

35

Odds Ratio (M‐H, Fixed, 95% CI)

0.92 [0.21, 4.00]

4 Number of units transfused Show forest plot

1

35

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.70, 0.70]

5 Operating time (in minutes) Show forest plot

1

35

Mean Difference (IV, Fixed, 95% CI)

‐13.40 [‐68.08, 41.28]

Figures and Tables -
Comparison 11. Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic)
Comparison 12. 30 minute intermittent PTC (30 min IPTC) versus 15 minute intermittent PTC (15 min IPTC)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Surgical morbidity Show forest plot

1

368

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.53, 2.67]

1.1 Bile leakage

1

92

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.20, 1.99]

1.2 Cholangitis

1

92

Risk Ratio (M‐H, Fixed, 95% CI)

5.44 [0.27, 110.37]

1.3 Wound infection

1

92

Risk Ratio (M‐H, Fixed, 95% CI)

3.27 [0.35, 30.31]

1.4 Pleural effusion

1

92

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.16, 7.42]

2 Number requiring blood transfusion Show forest plot

1

92

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.29, 4.10]

Figures and Tables -
Comparison 12. 30 minute intermittent PTC (30 min IPTC) versus 15 minute intermittent PTC (15 min IPTC)
Comparison 13. Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

3

210

Odds Ratio (M‐H, Fixed, 95% CI)

5.35 [0.25, 116.31]

2 Liver failure Show forest plot

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.86 [0.29, 2.55]

3 Other Morbidity Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Encephalopathy

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

3.10 [0.12, 79.23]

3.2 Ascites

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.13, 1.95]

3.3 Renal insufficiency

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.13, 7.60]

3.4 Re‐operation

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

3.10 [0.12, 79.23]

3.5 Biliary fistula

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.77 [0.19, 3.20]

3.6 Infection

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.62 [0.15, 2.45]

3.7 Respiratory complications

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.23, 4.43]

4 Blood loss (ml) Show forest plot

2

110

Mean Difference (IV, Fixed, 95% CI)

29.49 [‐238.64, 297.62]

5 Number of units transfused Show forest plot

1

60

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐1.41, 0.81]

6 Number needing Transfusion Show forest plot

1

50

Odds Ratio (M‐H, Fixed, 95% CI)

0.18 [0.01, 4.04]

7 Haemodynamic Changes (10 min) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Mean Arterial Pressure (mm Hg)

1

8

Mean Difference (IV, Fixed, 95% CI)

‐2.8 [‐22.07, 16.47]

7.2 Cardiac Index Litre/min/ sq m

1

8

Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐1.35, 1.05]

7.3 Stroke volume index (ml/ sq m)

1

8

Mean Difference (IV, Fixed, 95% CI)

‐33.0 [‐357.88, 291.88]

7.4 Systemic Vascular Resistance Index (dynes. sec 10^4 / cu cm)

1

8

Mean Difference (IV, Fixed, 95% CI)

9.5 [‐3.25, 22.25]

8 AST (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 First post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

‐193.6 [‐398.41, 11.21]

8.2 Second post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

‐141.0 [‐276.01, ‐5.99]

8.4 Seventh post‐operative day

1

60

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐17.63, 17.43]

8.5 Peak level

1

60

Mean Difference (IV, Fixed, 95% CI)

424.0 [‐213.22, 1061.22]

8.6 On discharge

1

60

Mean Difference (IV, Fixed, 95% CI)

‐1.80 [‐24.74, 21.14]

8.7 Day 30

1

60

Mean Difference (IV, Fixed, 95% CI)

‐7.30 [‐33.57, 18.97]

9 ALT (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 First post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

‐258.0 [‐453.54, ‐62.46]

9.2 Second post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

‐288.5 [‐581.56, 4.56]

9.4 Seventh post‐operative day

1

60

Mean Difference (IV, Fixed, 95% CI)

25.70 [‐6.63, 58.03]

9.5 Peak level

1

60

Mean Difference (IV, Fixed, 95% CI)

314.0 [‐49.17, 677.17]

9.6 On discharge

1

60

Mean Difference (IV, Fixed, 95% CI)

3.80 [‐25.24, 32.84]

9.7 Day 30

1

60

Mean Difference (IV, Fixed, 95% CI)

4.40 [‐15.26, 24.06]

10 Alpha Glutathione S‐tranferase (IU/L) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 Seventh post‐operative day

1

60

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐4.18, 0.18]

10.2 Peak value in 10 days

1

60

Mean Difference (IV, Fixed, 95% CI)

116.0 [10.09, 221.91]

11 Bilirubin (micromole/litre) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

11.3 Seventh post‐operative day

1

60

Mean Difference (IV, Fixed, 95% CI)

‐11.0 [‐45.20, 23.20]

11.4 Peak level

1

60

Mean Difference (IV, Fixed, 95% CI)

‐18.20 [‐51.46, 15.06]

11.5 On discharge

1

60

Mean Difference (IV, Fixed, 95% CI)

‐2.90 [‐17.54, 11.74]

11.6 Day 30

1

60

Mean Difference (IV, Fixed, 95% CI)

0.60 [‐28.31, 29.51]

12 Prothrombin time (percentage of normal) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

12.1 First post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

‐1.20 [‐8.96, 6.56]

12.2 Seventh post‐operative day

1

60

Mean Difference (IV, Fixed, 95% CI)

3.0 [‐4.24, 10.24]

12.3 Nadir level

1

60

Mean Difference (IV, Fixed, 95% CI)

3.80 [‐1.98, 9.58]

12.4 On discharge

1

60

Mean Difference (IV, Fixed, 95% CI)

2.0 [‐5.29, 9.29]

12.5 Day 30

1

60

Mean Difference (IV, Fixed, 95% CI)

1.30 [‐7.10, 9.70]

13 Creatinine (micromoles/litre) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

13.1 Peak

1

100

Mean Difference (IV, Fixed, 95% CI)

‐64.0 [‐83.79, ‐44.21]

14 Increase in lactate (mmol/L) (Systemic) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

14.1 3 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.45 [‐0.85, ‐0.05]

14.2 15 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.04, ‐0.16]

14.3 30 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.47 [‐0.90, ‐0.04]

14.4 2 hours

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.66 [‐1.14, ‐0.18]

15 Increase in lactate (mmol/L) (Portal) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

15.1 3 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.68 [‐0.79, ‐0.57]

15.2 15 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.44 [‐0.53, ‐0.35]

15.3 30 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.50 [‐0.61, ‐0.39]

16 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue) Show forest plot

1

50

Mean Difference (IV, Fixed, 95% CI)

52.1 [‐79.83, 184.03]

17 CD18 (Relative fluorescence units) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

17.1 3 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.2 15 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.3 30 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.4 2 hours

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.5 24 hours

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Inosine (Portal vein ‐ arterial) nmol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

18.1 3 minutes

1

37

Mean Difference (IV, Fixed, 95% CI)

‐274.0 [‐799.08, 251.08]

18.2 15 minutes

1

37

Mean Difference (IV, Fixed, 95% CI)

6.60 [‐7.50, 20.70]

19 Hypoxanthine (Portal vein ‐ arterial) micromol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

19.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

‐0.55 [‐1.76, 0.66]

19.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

‐0.17 [‐1.27, 0.93]

20 Xanthine (Portal vein ‐ arterial) micromol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

20.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

‐0.13 [‐0.33, 0.07]

20.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

1.44 [‐0.09, 2.97]

24 ITU stay (in days) Show forest plot

2

109

Mean Difference (IV, Fixed, 95% CI)

‐1.71 [‐2.23, ‐1.20]

25 Hospital Stay (in days) Show forest plot

2

109

Mean Difference (IV, Fixed, 95% CI)

‐1.88 [‐2.58, ‐1.19]

Figures and Tables -
Comparison 13. Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion)
Comparison 14. Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

60

Odds Ratio (M‐H, Random, 95% CI)

5.35 [0.25, 116.31]

2 Liver failure Show forest plot

1

60

Odds Ratio (M‐H, Random, 95% CI)

0.86 [0.29, 2.55]

3 Other morbidity Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Encephalopathy

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

3.10 [0.12, 79.23]

3.2 Ascites

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.13, 1.95]

3.3 Renal insufficiency

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.13, 7.60]

3.4 Re‐operation

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

3.10 [0.12, 79.23]

3.5 Biliary fistula

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.77 [0.19, 3.20]

3.6 Infection

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.62 [0.15, 2.45]

3.7 Respiratory complications

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.23, 4.43]

4 Blood loss (ml) Show forest plot

1

60

Mean Difference (IV, Random, 95% CI)

‐61.00 [‐466.17, 344.17]

5 Number of units transfused Show forest plot

1

60

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐1.41, 0.81]

6 AST (IU/L) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

6.4 Seventh post‐operative day

1

60

Mean Difference (IV, Random, 95% CI)

‐0.10 [‐17.63, 17.43]

6.5 Peak level

1

60

Mean Difference (IV, Random, 95% CI)

424.0 [‐213.22, 1061.22]

6.6 On discharge

1

60

Mean Difference (IV, Random, 95% CI)

‐1.80 [‐24.74, 21.14]

6.7 Day 30

1

60

Mean Difference (IV, Random, 95% CI)

‐7.30 [‐33.57, 18.97]

7 ALT (IU/L) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

7.4 Seventh post‐operative day

1

60

Mean Difference (IV, Random, 95% CI)

25.70 [‐6.63, 58.03]

7.5 Peak level

1

60

Mean Difference (IV, Random, 95% CI)

314.0 [‐49.17, 677.17]

7.6 On discharge

1

60

Mean Difference (IV, Random, 95% CI)

3.80 [‐25.24, 32.84]

7.7 Day 30

1

60

Mean Difference (IV, Random, 95% CI)

4.40 [‐15.26, 24.06]

8 Alpha Glutathione S‐tranferase (IU/L) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 Seventh post‐operative day

1

60

Mean Difference (IV, Random, 95% CI)

‐2.0 [‐4.18, 0.18]

8.2 Peak value in 10 days

1

60

Mean Difference (IV, Random, 95% CI)

116.0 [10.09, 221.91]

9 Bilirubin (micromole/litre) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

9.3 Seventh post‐operative day

1

60

Mean Difference (IV, Random, 95% CI)

‐11.0 [‐45.20, 23.20]

9.4 Peak level

1

60

Mean Difference (IV, Random, 95% CI)

‐18.20 [‐51.46, 15.06]

9.5 On discharge

1

60

Mean Difference (IV, Random, 95% CI)

‐2.90 [‐17.54, 11.74]

9.6 Day 30

1

60

Mean Difference (IV, Random, 95% CI)

0.60 [‐28.31, 29.51]

10 Prothrombin time (percentage of normal) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

10.1 Seventh post‐operative day

1

60

Mean Difference (IV, Random, 95% CI)

3.0 [‐4.24, 10.24]

10.2 Nadir level

1

60

Mean Difference (IV, Random, 95% CI)

3.80 [‐1.98, 9.58]

10.3 On discharge

1

60

Mean Difference (IV, Random, 95% CI)

2.0 [‐5.29, 9.29]

10.4 Day 30

1

60

Mean Difference (IV, Random, 95% CI)

1.30 [‐7.10, 9.70]

11 Hospital Stay (in days) Show forest plot

1

60

Mean Difference (IV, Random, 95% CI)

‐3.10 [‐7.30, 1.10]

12 ITU stay (in days) Show forest plot

1

60

Mean Difference (IV, Random, 95% CI)

‐0.90 [‐2.47, 0.67]

Figures and Tables -
Comparison 14. Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections)
Comparison 15. Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

3

210

Odds Ratio (M‐H, Random, 95% CI)

5.35 [0.25, 116.31]

2 Liver failure Show forest plot

1

60

Odds Ratio (M‐H, Random, 95% CI)

0.86 [0.29, 2.55]

3 Other Morbidity Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Encephalopathy

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

3.10 [0.12, 79.23]

3.2 Ascites

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.13, 1.95]

3.3 Renal insufficiency

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.13, 7.60]

3.4 Re‐operation

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

3.10 [0.12, 79.23]

3.5 Biliary fistula

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.77 [0.19, 3.20]

3.6 Infection

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.62 [0.15, 2.45]

3.7 Respiratory complications

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.23, 4.43]

4 Blood loss (ml) Show forest plot

2

110

Mean Difference (IV, Random, 95% CI)

29.49 [‐238.64, 297.62]

5 Number of units transfused Show forest plot

1

60

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐1.41, 0.81]

6 Number needing Transfusion Show forest plot

1

50

Odds Ratio (M‐H, Fixed, 95% CI)

0.18 [0.01, 4.04]

7 Haemodynamic Changes (10 min) Show forest plot

1

32

Mean Difference (IV, Fixed, 95% CI)

‐0.08 [‐1.27, 1.11]

7.1 Mean Arterial Pressure (mm Hg)

1

8

Mean Difference (IV, Fixed, 95% CI)

‐2.8 [‐22.07, 16.47]

7.2 Cardiac Index Litre/min/ sq m

1

8

Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐1.35, 1.05]

7.3 Stroke volume index (ml/ sq m)

1

8

Mean Difference (IV, Fixed, 95% CI)

‐33.0 [‐357.88, 291.88]

7.4 Systemic Vascular Resistance Index (dynes. sec 10^4 / cu cm)

1

8

Mean Difference (IV, Fixed, 95% CI)

9.5 [‐3.25, 22.25]

8 AST (IU/L) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 First post‐operative day

1

50

Mean Difference (IV, Random, 95% CI)

‐193.6 [‐398.41, 11.21]

8.2 Second post‐operative day

1

50

Mean Difference (IV, Random, 95% CI)

‐141.0 [‐276.01, ‐5.99]

8.4 Seventh post‐operative day

1

60

Mean Difference (IV, Random, 95% CI)

‐0.10 [‐17.63, 17.43]

8.5 Peak level

1

60

Mean Difference (IV, Random, 95% CI)

424.0 [‐213.22, 1061.22]

8.6 On discharge

1

60

Mean Difference (IV, Random, 95% CI)

‐1.80 [‐24.74, 21.14]

8.7 Day 30

1

60

Mean Difference (IV, Random, 95% CI)

‐7.30 [‐33.57, 18.97]

9 ALT (IU/L) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

9.1 First post‐operative day

1

50

Mean Difference (IV, Random, 95% CI)

‐258.0 [‐453.54, ‐62.46]

9.2 Second post‐operative day

1

50

Mean Difference (IV, Random, 95% CI)

‐288.5 [‐581.56, 4.56]

9.4 Seventh post‐operative day

1

60

Mean Difference (IV, Random, 95% CI)

25.70 [‐6.63, 58.03]

9.5 Peak level

1

60

Mean Difference (IV, Random, 95% CI)

314.0 [‐49.17, 677.17]

9.6 On discharge

1

60

Mean Difference (IV, Random, 95% CI)

3.80 [‐25.24, 32.84]

9.7 Day 30

1

60

Mean Difference (IV, Random, 95% CI)

4.40 [‐15.26, 24.06]

10 Alpha Glutathione S‐tranferase (IU/L) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

10.1 Seventh post‐operative day

1

60

Mean Difference (IV, Random, 95% CI)

‐2.0 [‐4.18, 0.18]

10.2 Peak value in 10 days

1

60

Mean Difference (IV, Random, 95% CI)

116.0 [10.09, 221.91]

11 Bilirubin (micromole/litre) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

11.3 Seventh post‐operative day

1

60

Mean Difference (IV, Random, 95% CI)

‐11.0 [‐45.20, 23.20]

11.4 Peak level

1

60

Mean Difference (IV, Random, 95% CI)

‐18.20 [‐51.46, 15.06]

11.5 On discharge

1

60

Mean Difference (IV, Random, 95% CI)

‐2.90 [‐17.54, 11.74]

11.6 Day 30

1

60

Mean Difference (IV, Random, 95% CI)

0.60 [‐28.31, 29.51]

12 Prothrombin time (percentage of normal) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

12.1 First post‐operative day

1

50

Mean Difference (IV, Fixed, 95% CI)

‐1.20 [‐8.96, 6.56]

12.2 Seventh post‐operative day

1

60

Mean Difference (IV, Fixed, 95% CI)

3.0 [‐4.24, 10.24]

12.3 Nadir level

1

60

Mean Difference (IV, Fixed, 95% CI)

3.80 [‐1.98, 9.58]

12.4 On discharge

1

60

Mean Difference (IV, Fixed, 95% CI)

2.0 [‐5.29, 9.29]

12.5 Day 30

1

60

Mean Difference (IV, Fixed, 95% CI)

1.30 [‐7.10, 9.70]

13 Creatinine (micromoles/litre) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

13.1 Peak

1

100

Mean Difference (IV, Fixed, 95% CI)

‐64.0 [‐83.79, ‐44.21]

14 Increase in lactate (mmol/L) (Systemic) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

14.1 3 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.45 [‐0.85, ‐0.05]

14.2 15 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.04, ‐0.16]

14.3 30 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.47 [‐0.90, ‐0.04]

14.4 2 hours

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.66 [‐1.14, ‐0.18]

15 Increase in lactate (mmol/L) (Portal) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

15.1 3 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.68 [‐0.79, ‐0.57]

15.2 15 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.44 [‐0.53, ‐0.35]

15.3 30 minutes

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.50 [‐0.61, ‐0.39]

16 Increase in myeloperoxidase activity (one hour post‐op) (ng/mg of total protein of liver tissue) Show forest plot

1

50

Mean Difference (IV, Random, 95% CI)

52.1 [‐79.83, 184.03]

17 CD18 (Relative fluorescence units) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

17.1 3 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.2 15 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.3 30 minutes

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.4 2 hours

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.5 24 hours

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Inosine (Portal vein ‐ arterial) nmol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

18.1 3 minutes

1

37

Mean Difference (IV, Fixed, 95% CI)

‐274.0 [‐799.08, 251.08]

18.2 15 minutes

1

37

Mean Difference (IV, Fixed, 95% CI)

6.60 [‐7.50, 20.70]

19 Hypoxanthine (Portal vein ‐ arterial) micromol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

19.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

‐0.55 [‐1.76, 0.66]

19.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

‐0.17 [‐1.27, 0.93]

20 Xanthine (Portal vein ‐ arterial) micromol/litre Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

20.1 3 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

‐0.13 [‐0.33, 0.07]

20.2 15 minutes

1

32

Mean Difference (IV, Fixed, 95% CI)

1.44 [‐0.09, 2.97]

21 ITU stay (in days) Show forest plot

2

109

Mean Difference (IV, Random, 95% CI)

‐1.67 [‐2.32, ‐1.02]

22 Hospital Stay (in days) Show forest plot

2

109

Mean Difference (IV, Random, 95% CI)

‐1.88 [‐2.58, ‐1.19]

Figures and Tables -
Comparison 15. Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Non‐cirhhotic)
Comparison 16. Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

2

127

Odds Ratio (M‐H, Fixed, 95% CI)

3.17 [0.12, 80.38]

2 Liver failure Show forest plot

1

73

Odds Ratio (M‐H, Fixed, 95% CI)

0.19 [0.01, 4.20]

3 Other morbidity Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Biliary leak

2

127

Odds Ratio (M‐H, Fixed, 95% CI)

1.47 [0.44, 4.95]

3.2 Intra‐abdominal abscess

1

73

Odds Ratio (M‐H, Fixed, 95% CI)

1.03 [0.19, 5.48]

3.3 Wound infection

1

73

Odds Ratio (M‐H, Fixed, 95% CI)

0.67 [0.10, 4.25]

3.4 Respiratory complications

2

127

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.24, 2.23]

4 Blood loss (ml) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 Transection

1

73

Mean Difference (IV, Fixed, 95% CI)

‐104.0 [‐230.54, 22.54]

4.2 Operative

2

127

Mean Difference (IV, Fixed, 95% CI)

‐164.73 [‐271.83, ‐57.64]

5 Number of units transfused Show forest plot

1

73

Mean Difference (IV, Fixed, 95% CI)

‐1.2 [‐2.33, ‐0.07]

6 Number needing transfusion Show forest plot

1

73

Odds Ratio (M‐H, Fixed, 95% CI)

0.79 [0.28, 2.21]

7 AST (IU/L) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 First post‐operative day

1

54

Mean Difference (IV, Fixed, 95% CI)

14.0 [‐87.19, 115.19]

7.2 Third post‐operative day

1

54

Mean Difference (IV, Fixed, 95% CI)

66.0 [4.69, 127.31]

7.3 Sixth post‐operative day

1

54

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐7.07, 3.07]

7.4 Peak level

1

73

Mean Difference (IV, Fixed, 95% CI)

117.0 [‐66.53, 300.53]

8 ALT (IU/L) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 Peak level

1

73

Mean Difference (IV, Fixed, 95% CI)

‐108.0 [‐277.77, 61.77]

9 Bilirubin (micromole/litre) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 First post‐operative day

1

54

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐3.40, 5.40]

9.2 Third post‐operative day

1

54

Mean Difference (IV, Fixed, 95% CI)

0.5 [‐3.76, 4.76]

9.3 Sixth post‐operative day

1

54

Mean Difference (IV, Fixed, 95% CI)

3.80 [‐0.10, 7.70]

9.4 Peak level

1

73

Mean Difference (IV, Fixed, 95% CI)

1.80 [‐27.74, 31.34]

10 Prothrombin time (percentage of normal) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 First post‐operative day

1

54

Mean Difference (IV, Fixed, 95% CI)

0.90 [‐2.54, 4.34]

10.2 Third post‐operative day

1

54

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐2.84, 3.04]

10.3 Sixth post‐operative day

1

54

Mean Difference (IV, Fixed, 95% CI)

‐2.30 [‐5.58, 0.98]

10.4 Nadir level

1

73

Mean Difference (IV, Fixed, 95% CI)

1.90 [‐6.28, 10.08]

11 Caspase‐3 Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

12 Apoptotic bodies Show forest plot

1

54

Mean Difference (IV, Fixed, 95% CI)

3.0 [0.22, 5.78]

13 Operating time Show forest plot

2

127

Mean Difference (IV, Random, 95% CI)

‐13.82 [‐51.17, 23.54]

14 ITU stay (in days) Show forest plot

1

73

Mean Difference (IV, Fixed, 95% CI)

2.2 [‐0.34, 4.74]

15 Hospital stay (in days) Show forest plot

2

127

Mean Difference (IV, Random, 95% CI)

‐0.10 [‐2.79, 2.60]

Figures and Tables -
Comparison 16. Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC)