Effect of sevoflurane on grafted kidney function in renal transplantation

Abstract

Background: The objective of this retrospective study was to determine if there are any differences in grafted kidney function in recipients of kidney transplantation (KT) when donors and recipients were anesthetized with sevoflurane compared to desflurane.

Methods: Seventy-three pairs of donors-recipients were anesthetized with sevoflurane (Sevo group) and 71 pairs were anesthetized with desflurane (Des group). We retrospectively investigated the blood urea nitrogen (BUN) levels, creatinine (Cr) levels, and estimated glomerular filtration rates (eGFR) of the recipients in both groups for 1 year postoperatively. We tested non-inferiority for serum creatinine at discharge and 1 year after KT. Short-term (1 year) outcomes of KT were assessed by the incidence of delayed graft function (DGF), acute rejection episodes (ARE), and graft failure.

Results: There were no differences in BUN, Cr, eGFR, or outcomes of KT at 1 year postoperatively. Specifically, the 95% confidence interval for the difference in creatinine levels between the Sevo and Des groups was less than the margin of equivalence at the time of discharge and 1 year after surgery. The occurrences of DGF, ARE, and graft failure were comparable between the groups.

Conclusions: Compared to desflurane, sevoflurane had no adverse effects on grafted renal function or on the short-term outcome of renal transplantation.

Keywords: Creatinine; Glomerular filtration rate; Kidney transplantation; Sevoflurane.

Fig. 1

Flowchart of data acquisition. Of the patients who underwent kidney transplantation from a living donor from January 2006 to June 2009, this study included donor-recipient pairs in which the recipient had been anesthetized with the same volatile anesthetic as the donor. We excluded the pairs in which isoflurane was used because of the small sample size. Finally, the enrolled pairs were divided into groups, the sevoflurane group (n = 73, Sevo group) and the desflurane group (n = 71, Des group). IMR, incomplete medical record; UHE, unstable hemodynamic event during transplantation.

Fig. 2

Transplanted renal function in the immediate postoperative period. Changes in serum blood urea nitrogen (BUN), creatinine (Cr) level, estimated glomerular filtration rate (eGFR), and urine output in the Des group (□) and in the Sevo group (•) during the immediate postoperative period. The changes in the serum concentrations of BUN, Cr, eGFR, and urine output of the recipients during the immediate postoperative period were comparable between the two groups.