Transplant Trial Watch

The Effect of Pringle Maneuver Applied during Living Donor Hepatectomy on the Ischemia-Reperfusion Injury Observed in the Donors and Recipients.

Dalda, Y., et al.

Medicina 2024; 60(4): 18.

This study aimed to assess how the application of the pringle maneuver during living donor hepatectomy affects ischemia and reperfusion Injury in the donors and recipients.

Donors were randomised into two groups: the pringle maneuver applied group or the pringle maneuver not applied group.

A total of 108 patients: 54 living liver donors (LLDs) and 54 liver transplant recipients.

The effect of the pringle maneuver and clinical implications of ischemia-reperfusion injury were assessed by measuring complete blood count, coagulation tests, liver function tests, interleukin-1 (IL-1), IL-2, IL-6, tumor necrosis factor-α (TNF-α), β-Galactosidase (β-Gal) measurements, and histopathological findings.

5 days post-operation

CET Conclusions
The Pringle manoeuvre, where hepatic blood inflow is occluded during hepatic dissection, is often employed in donor hepatectomy to reduce blood loss. This randomised study aimed to determine whether this period of ischaemia contributes to the ischaemia-reperfusion injury (IRI) inherent in living donor liver transplantation. 54 donor-recipient pairs were randomised to either receive the Pringle manoeuvre (10 minutes) or not. The primary outcomes included liver function tests for the first 5 days post-operatively, cytokine measures of IRI and histopathological changes on post-hepatectomy specimens. There was no significant difference in liver function or measures of IRI between the two groups. On microscopy, the authors reported an increased score of ‘hepatocyte damage’ in the Pringle group. However, as a validated scoring system for this assessment was not used, the significance of this difference is unclear. Compared to other studies, the duration that the Pringle manoeuvre was applied in this study is relatively short. This, with the short follow up period, likely accounts for the lack of effect demonstrated here.

Jadad score

Data analysis
Per protocol analysis

Allocation concealment

Trial registration

Funding source
Non-industry funded