The Influence of Pharmacological Peconditioning with Sevoflurane on Incidence of Early Allograft Dysfunction in Liver Transplant Recipients.

Anesthesiology Research and Practice 2012; 930487.

Aims
To evaluate the effect of sevoflurane preconditioning of liver grafts from deceased brain donors on postoperative graft function in patients undergoing liver transplantation.

Interventions
Donors had pharmacological preconditioning with end-expiratory sevoflurane of 2.0 volume% in a mixture of oxygen and air during the entire procedure of organ procurement versus a mixture of oxygen and air without any volatile anesthetic. All donors received a bolus of 3 μg/kg fentanyl and a bolus of 12 mg pipecuronium bromide at the beginning of the procurement procedure. All patients were given intraoperative 500 mg methylprednisolone as induction of immunosuppression.

Participants
60 deceased brain liver donors.

Outcomes
Primary endpoint was postoperative liver injury assessed by peak serum values of alanine aminotransferas and aspartate aminotransferase. Secondary endpoint was incidence of early allograft dysfunction.

Follow-up
7 days

CET Conclusions
In this randomized study brain-death donors were allocated to receive sevoflurane or anaesthesia with a non-volatile anaesthetic. Randomization was done at the start of the procurement procedure. Peak AST levels in the first 48 hours were lower in the sevoflurane group. Due to this association, sevoflurane was also related to a reduction in early allograft dysfunction. Peak ALT levels were not different between the two groups. Due to the size of the study it was underpowered to assess for the effect of sevoflurane on subgroups with and without hepatic steatosis.

Jadad score
4

Data analysis
Per protocol analysis

Allocation concealment
Yes

Trial registration
Not reported

Funding source
Not reported