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The Impact of the Analgesic Agents Administered in Recipients of Liver Transplants on Graft Results

Author(s): Saracoglu A, Tanirgan Çabakli G, Kelleci Y, Bilgili B, Yegen C, Umuroglu T

Introduction and Objective

The ischemia-reperfusion injury that occurs in both the donor and the recipient during liver transplantation and the hemodynamic changes that may occur in graft afterward significantly affect the graft, sometimes triggering graft failure by causing hepatocyte damage. It is known that inhalation anesthetics provide ischemic preconditioning that prevents ischemia-reperfusion injury, but their effect on graft dysfunction caused by post-reperfusion syndrome has not yet been clarified. Our study aimed to reveal the effects of desflurane and sevoflurane used during liver transplantation on graft survival.

Material and Method

This retrospective study was conducted following the ethics committee approval (protocol no: 09.2021.1004/03.09.2021) and included 60 donors and recipients of liver transplantation procedures performed between 2015 and 2021. The patients were divided into two groups depending on the agent administered for anesthesia maintenance after standard anesthesia induction: desflurane group (Group 1, n=30) and sevoflurane group (Group 2, n=30).

Recorded patient data included age, gender, body mass index, smoking status, comorbidities, presence of renal disease, total liver volume, graft volume, remaining liver volume, total ischemic time, and duration of anesthesia and surgery, graft survival, hospital stay, diastolic blood pressure measured at the beginning and the end of the procedure, systolic blood pressure; and the values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalized ratio (INR), albumin, total bilirubin, blood urea nitrogen, creatinine, platelet count, and hemoglobin at the postoperative 1, 7, and 30 days.

Results

Demographic data and length of hospital stay of the recipients were similar (p>0.05). Intraoperative urine output of the recipient patients in the desflurane group (Group 1: 1909.52±1269.90, Group 2: 918.75±618.14), ALT level at postoperative 7th day, and total bilirubin value at the 6th month were found to be significantly higher compared to the sevoflurane group (p <0.01).

Discussion and Conclusion

Our study revealed that preconditioning with sevoflurane during liver transplantation may have greater positive effects on early hepatic and renal functions as compared to desflurane. However, we think that it is necessary to carry out further prospective randomized studies.

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