Oxothiazolidine Carboxylate Provides Protection against Hepatocellular Injury Seen after Porta Hepatis Occlusion (Pringle Maneuver) under Hypovolemic Conditions

The sensitivity of liver to warm ischemia has always been a concern for surgeons. To monitor the ischemia and/or reperfusion injury after the Pringle maneuver (occlusion of porta hepatis) in livers subjected to hemorrhage, blood pressure, blood pH, base deficit (BE), serum alanine aminotransferase (ALT), serum and liver malondialdehyde (MDA), and liver glutathione (GSH) levels were measured. MDA is a by‐product of oxidant induced lipid peroxidation, and GSH is an endogenous antioxidant. The effect of lactated Ringer’s (LR) resuscitation with or without the addition of 2‐oxothiazolidine‐4‐carboxylate (OTC), a cysteine prodrug (enhancing glutathione production) on liver injury, if any, were investigated. Rats in the sham group (n = 8) and five other groups (n = 8) underwent femoral artery and vein catheterization and laparotomy. The hemorrhage group was bled 30% of their blood volume and the ischemia group underwent occlusion of the porta hepatis 30 minutes. The hemorrhage‐ischemia (HI), LR, and OTC groups underwent both hemorrhage and occlusion. The LR and OTC groups, 30 minutes after hemorrhage, received either LR resuscitation (equivalent to three times the shed blood) or LR resuscitation plus IV OTC (100 mg/kg before clamping and 100 mg/kg after de‐clamping). Porta hepatis occlusion in the presence of hypovolemia (HI group) caused an increase in serum ALT, plasma MDA, liver MDA, and base deficit and a decrease in blood pH levels. LR resuscitation lowered only MDA (plasma and liver) and base deficit but did not reduce ALT and increase blood pH. Although liver GSH did not change, OTC kept all parameters at control levels. OTC prevents the deleterious effects of total hepatic inflow occlusion under hypovolemic conditions, but this does not occur through enhancement liver glutathione production. OTC may protect the liver by accelerating hepatic glutathione turnover, but further studies are needed to explain its mechanism of action.