Impact of propofol versus desflurane anesthesia on postoperative hepatic and renal functions in infants with living-related liver transplantation: a randomized controlled trial

Abstract

Background: The effects of anesthetics on liver and kidney functions after infantile living-related liver transplantation (LRLT) are unclear. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) or desflurane-based inhalation anesthesia on postoperative liver and kidney functions in infant recipients after LRLT and to evaluate hepatic ischemia-reperfusion injury (HIRI).

Methods: Seventy-six infants with congenital biliary atresia scheduled for LRLT were randomly divided into two anesthesia maintenance groups: group D with continuous inhalation of desflurane and group P with an infusion of propofol. The primary focus was to assess alterations of liver transaminase and serum creatinine (Scr) levels within the first 7 days after surgery. And the peak aminotransferase level within 72 h post-surgery was used as a surrogate marker for HIRI.

Results: There were no differences in preoperative hepatic and renal functions between the two groups. Upon the intensive care unit (ICU) arrival, the levels of aspartate aminotransferase (AST, P = 0.001) and alanine aminotransferase (ALT, P = 0.005) in group P were significantly lower than those in group D. These changes persisted until the fourth and sixth days after surgery. The peak AST and ALT levels within 72 h after surgery were also lower in group P than in group D (856 (552, 1221) vs. 1468 (732, 1969) U/L, P = 0.001 (95% CI: 161-777) and 517 (428, 704) vs. 730 (541, 1100) U/L, P = 0.006, (95% CI: 58-366), respectively). Patients in group P had lower levels of Scr upon the ICU arrival and on the first day after surgery, compared to group D (17.8 (15.2, 22.0) vs. 23.0 (20.8, 30.8) μmol/L, P < 0.001 (95% CI: 3.0-8.7) and 17.1 (14.9, 21.0) vs. 20.5 (16.5, 25.3) μmol/L, P = 0.02 (95% CI: 0.0-5.0) respectively). Moreover, the incidence of severe acute kidney injury was significantly lower in group P compared to that in group D (15.8% vs. 39.5%, P = 0.038).

Conclusions: Propofol-based TIVA might improve liver and kidney functions after LRLT in infants and reduce the incidence of serious complications, which may be related to the reduction of HIRI. However, further biomarkers will be necessary to prove these associations.

Keywords: Desflurane; Hepatic function; Infant; Living-related liver transplantation; Propofol; Renal function.

Fig. 1

The anesthesia, operation stages, and time points of this study. ALP alkaline phosphatase, ALT alanine aminotransferase, AST aspartate aminotransferase, BUN blood urea nitrogen, GGT gamma-glutamyl transferase, ICU intensive care unit, LDH lactate dehydrogenase, KDIGO Kidney Disease: Improving Global Outcomes, POD postoperative days, Scr serum creatinine, TB total bilirubin, TIVA total intravenous anesthesia

Fig. 2

Vital signs at six time points. A Heart rate (HR). B Mean arterial pressure (MAP). C Central venous pressure (CVP). D Temperature (Temp). Values are presented as median (IQR); ^*P < 0.01

Fig. 3

Aminotransferase peak of liver transplantation recipients within 7 days of surgery. A ALT peak. B AST peak. ALT alanine aminotransferase, AST aspartate aminotransferase; ^**P < 0.01

Fig. 4

Liver and kidney function tests of liver transplantation recipients. A Alanine transaminase (ALT). B Aspartate aminotransferase (AST). C Total bilirubin (TB). D alkaline phosphatase (ALP). E Gamma-glutamyl transpeptidase (GGT). F Lactate dehydrogenase (LDH). POD postoperative days. Values are presented as median (IQR); ^*P < 0.05, ^**P < 0.01

Fig. 5

Kidney function tests of liver transplantation recipients. A Serum creatinine (Scr). B Blood urea nitrogen (BUN). POD postoperative days. Values are presented as median (IQR); ^*P < 0.05, ^***P < 0.001

Fig. 6

The prevalence of postoperative AKI according to KDIGO criteria. A The prevalence of postoperative AKI within 7 days of surgery. B Distribution of different stages of AKI. C Occurrence of mild to severe AKI. AKI acute kidney injury. KDIGO Kidney Disease: Improving Global Outcomes; ^*P < 0.05

Fig. 7

Complications and Outcomes of the two groups. A Duration of mechanical ventilation. B Length of ICU stay. C Length of hospital stay. ICU intensive care unit