Perioperation ulinastatin intervention protects liver function in hepatectomy: A systematic review of randomized controlled trials and meta-analysis

Abstract

Background: Vascular occlusion during hepatectomy accompanies ischemia-reperfusion (IR) injury, which can cause liver dysfunction and affect patients' outcome. Ulinastatin or urinary trypsin inhibitor (UTI), a polyvalent inhibitor of various enzymes, has been confirmed of anti-IR injury effect in recent studies. Here we performed a systematic review and meta-analysis to assess the benefits of perioperation UTI using to protect liver function in hepatectomy. Methods: Randomized controlled trials (RCTs) evaluating UTI in hepatectomy were identified. Two independent reviewers extracted data on basic characteristics and risk of bias in the studies, and on outcomes such as alanine transaminase (ALT), aspartate transaminase (AST), and total bilirubin (TBIL) from 1 to 7 days after operation. Results: A total of 9 RCTs including 408 UTI and 372 control participants were identified. There was no significant difference in basic characteristics such as age or sex. The majority of the patients who underwent hepatectomy had primary liver carcinoma, liver metastases and benign liver lesions. A significant improvement in liver function was associated with UTI use not only at 1 and 3 days postoperatively, but also at 7 days (all P=0.01). However, significant heterogeneity existed between the pooled studies (all P<0.01). Conclusions: UTI has positive protective effects against IR injury in hepatectomy. However, further highquality RCTs are needed to confirm this conclusion.