Methods of vascular occlusion for elective liver resections

Kurinchi Selvan Gurusamy; Yogesh Kumar; Dinesh Sharma; Brian R Davidson

doi:10.1002/14651858.CD006409.pub2

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Figure 1

Figure 01

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

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

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Analysis 1.4

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

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Analysis 1.5

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

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Analysis 1.6

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

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Analysis 1.7

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

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Analysis 1.8

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

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Analysis 1.9

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

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Analysis 1.10

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

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Analysis 1.11

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

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Analysis 1.12

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

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Analysis 1.13

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

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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).

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Analysis 1.15

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

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Analysis 1.16

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

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Analysis 1.17

Comparison 1 Vascular occlusion versus 'no vascular occlusion', Outcome 17 Hypoxanthine (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.

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Analysis 1.19

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

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Analysis 1.20

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

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Analysis 2.1

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

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Analysis 2.2

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

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Analysis 2.3

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

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Analysis 2.4

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

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Analysis 3.1

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

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Analysis 3.2

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

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Analysis 3.3

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

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Analysis 3.4

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

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Analysis 3.5

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

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Analysis 3.6

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

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Analysis 3.7

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

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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).

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Analysis 3.9

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

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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).

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Analysis 3.11

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

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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.

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Analysis 3.13

Comparison 3 Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic), Outcome 13 Hypoxanthine (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.

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Analysis 3.15

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

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Analysis 3.16

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

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Analysis 4.1

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

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Analysis 4.2

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

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Analysis 4.3

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

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Analysis 4.4

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

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Analysis 5.1

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

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Analysis 5.2

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

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Analysis 5.3

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

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Analysis 5.4

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

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Analysis 5.5

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

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Analysis 5.6

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

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Analysis 5.7

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

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Analysis 5.8

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

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Analysis 5.9

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

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Analysis 5.10

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

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Analysis 5.11

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

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Analysis 5.12

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

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Analysis 5.13

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

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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).

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Analysis 5.15

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

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Analysis 5.16

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

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Analysis 5.18

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

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Analysis 5.19

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

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Analysis 6.1

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

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Analysis 6.2

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

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Analysis 6.3

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

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Analysis 6.4

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

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Analysis 6.5

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

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Analysis 6.6

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

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Analysis 6.7

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

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Analysis 6.8

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

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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).

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Analysis 6.10

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

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Analysis 6.11

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

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Analysis 6.12

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

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Analysis 7.1

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

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Analysis 7.2

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

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Analysis 7.3

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

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Analysis 7.4

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

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Analysis 7.5

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

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Analysis 7.6

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

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Analysis 7.7

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

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Analysis 7.9

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

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Analysis 7.10

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

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Analysis 7.11

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

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Analysis 7.12

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

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Analysis 8.1

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

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Analysis 8.2

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

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Analysis 8.3

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

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Analysis 8.4

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

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Analysis 8.5

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

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Analysis 8.6

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

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Analysis 8.7

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

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Analysis 8.8

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

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Analysis 8.9

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

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Analysis 8.10

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

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Analysis 8.11

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

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Analysis 8.12

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

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Analysis 9.1

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

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Analysis 9.2

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

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Analysis 9.3

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

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Analysis 9.4

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

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Analysis 9.5

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

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Analysis 9.6

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

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Analysis 9.7

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

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Analysis 9.8

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

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Analysis 10.1

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

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Analysis 10.2

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

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Analysis 10.3

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

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Analysis 10.4

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

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Analysis 10.5

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

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Analysis 10.6

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

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Analysis 10.7

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

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Analysis 10.8

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

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Analysis 10.9

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

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Analysis 10.10

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

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Analysis 10.11

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

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Analysis 10.12

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

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Analysis 11.1

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

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Analysis 11.2

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

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Analysis 11.3

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

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Analysis 11.4

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

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Analysis 11.5

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

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Analysis 12.1

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

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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.

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Analysis 13.1

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

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Analysis 13.2

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

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Analysis 13.3

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

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Analysis 13.4

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

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Analysis 13.5

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

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Analysis 13.6

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

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Analysis 13.7

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

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Analysis 13.8

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

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Analysis 13.9

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

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Analysis 13.10

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

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Analysis 13.11

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

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Analysis 13.12

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

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Analysis 13.13

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

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Analysis 13.14

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

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Analysis 13.15

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

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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).

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Analysis 13.17

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

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Analysis 13.18

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

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Analysis 13.19

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

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Analysis 13.20

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

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Analysis 13.24

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

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Analysis 13.25

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

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Analysis 14.1

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

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Analysis 14.2

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

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Analysis 14.3

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

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Analysis 14.4

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

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Analysis 14.5

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

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Analysis 14.6

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

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Analysis 14.7

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

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Analysis 14.8

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

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Analysis 14.9

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

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Analysis 14.10

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

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Analysis 14.11

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

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Analysis 14.12

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

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Analysis 15.1

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

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Analysis 15.2

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

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Analysis 15.3

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

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Analysis 15.4

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

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Analysis 15.5

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

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Analysis 15.6

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

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Analysis 15.7

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

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Analysis 15.8

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

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Analysis 15.9

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

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Analysis 15.10

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

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Analysis 15.11

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

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Analysis 15.12

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

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Analysis 15.13

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

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Analysis 15.14

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

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Analysis 15.15

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

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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).

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Analysis 15.17

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

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Analysis 15.18

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

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Analysis 15.19

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

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Analysis 15.20

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

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Analysis 15.21

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

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Analysis 15.22

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

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Analysis 16.1

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

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Analysis 16.2

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

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Analysis 16.3

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

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Analysis 16.4

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

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Analysis 16.5

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

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Analysis 16.6

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

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Analysis 16.7

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

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Analysis 16.8

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

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Analysis 16.9

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

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Analysis 16.10

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

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Analysis 16.11

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

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Analysis 16.12

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

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Analysis 16.13

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

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Analysis 16.14

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

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Analysis 16.15

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

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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 blindOR placebo OR meta‐analysis) #9 #8 AND #7

Table 1. Search strategies for identification of studies

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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	‐

Table 2. Mortality and causes

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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.

Table 3. "Vascular occlusion" versus "No vascular occlusion"

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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)

Table 4. Methods of vascular occlusion

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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

Table 5. Ischaemic preconditioning

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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]

Comparison 1. Vascular occlusion versus 'no vascular occlusion'

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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]

Comparison 2. Vascular occlusion versus 'no vascular occlusion' (Major resections)

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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]

Comparison 3. Vascular occlusion versus 'no vascular occlusion' (Non‐cirrhotic)

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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]

Comparison 4. Vascular occlusion versus 'no vascular occlusion' (Cirrhotic)

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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]

Comparison 5. Intermittent vascular occlusion versus 'no vascular occlusion'

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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]

Comparison 6. Hepatic vascular exclusion (HVE) versus portal triad clamping (PTC)

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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]

Comparison 7. Inflow occlusion: 'total' versus 'selective'

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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]

Comparison 8. Inflow occlusion: 'total' versus 'selective' (Minor resections)

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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]

Comparison 9. Inflow occlusion: 'total' versus 'selective' (Cirrhotic)

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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]

Comparison 10. Portal triad clamping: 'continuous' versus 'intermittent'

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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]

Comparison 11. Portal triad clamping: 'continuous' versus 'intermittent' (Cirrhotic)

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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]

Comparison 12. 30 minute intermittent PTC (30 min IPTC) versus 15 minute intermittent PTC (15 min IPTC)

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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]

Comparison 13. Ischaemic pre‐conditioning (IPC) versus control (continuous vascular occlusion)

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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]

Comparison 14. Ischaemic preconditioning (IPC) versus control (continuous vascular occlusion) (Major resections)

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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]

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

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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]

Comparison 16. Ischaemic preconditioning followed by continuous PTC (IPC) versus intermittent PTC (IPTC)

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