Department of Anaesthesiology.
Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Br J Anaesth. 2017 May 1;118(5):720-732. doi: 10.1093/bja/aex057.
Kidney transplantation is associated with harmful processes affecting the viability of the graft. One of these processes is associated with the phenomenon of ischaemia-reperfusion injury. Anaesthetic conditioning is a widely described strategy to attenuate ischaemia-reperfusion injury. We therefore conducted the Volatile Anaesthetic Protection of Renal Transplants-1 trial, a pilot project evaluating the influence of two anaesthetic regimens, propofol- vs sevoflurane-based anaesthesia, on biochemical and clinical outcomes in living donor kidney transplantation.
Sixty couples were randomly assigned to the following three groups: PROP (donor and recipient propofol), SEVO (donor and recipient sevoflurane), and PROSE (donor propofol and recipient sevoflurane). The primary outcome was renal injury reflected by urinary biomarkers. The follow-up period was 2 yr.
Three couples were excluded, leaving 57 couples for analysis. Concentrations of kidney injury molecule-1 (KIM-1), N -acetyl-β- d -glucosaminidase (NAG), and heart-type fatty acid binding protein (H-FABP) in the first urine upon reperfusion showed no differences. On day 2, KIM-1 concentrations were higher in SEVO [952.8 (interquartile range 311.8-1893.0) pg mmol -1 ] compared with PROP [301.2 (202.0-504.7) pg mmol -1 ]. This was the same for NAG: SEVO, 1.835 (1.162-2.457) IU mmol -1 vs PROP, 1.078 (0.819-1.713) IU mmol -1 . Concentrations of H-FABP showed no differences. Measured glomerular filtration rate at 3, 6, and 12 months showed no difference. After 2 yr, there was a difference in the acute rejection rate ( P =0.039). Post hoc testing revealed a difference between PROP (35%) and PROSE (5%; P =0.020). The difference between PROP and SEVO (11%) was not significant ( P =0.110).
The SEVO group showed higher urinary KIM-1 and NAG concentrations in living donor kidney transplantation on the second day after transplantation. This was not reflected in inferior graft outcome.
NCT01248871.
肾移植会导致影响移植物活力的有害过程。其中一个过程与缺血再灌注损伤现象有关。麻醉预处理是一种广泛描述的策略，可减轻缺血再灌注损伤。因此，我们进行了挥发性麻醉保护肾移植-1 试验，这是一项试点项目，评估了两种麻醉方案（异丙酚与七氟醚麻醉）对活体供肾移植中生化和临床结局的影响。
60 对夫妇被随机分配到以下三组：PROP（供体和受体异丙酚）、SEVO（供体和受体七氟醚）和 PROSE（供体异丙酚和受体七氟醚）。主要结局是反映尿液生物标志物的肾损伤。随访时间为 2 年。
3 对夫妇被排除，57 对夫妇进行了分析。再灌注后第一次尿液中肾损伤分子-1（KIM-1）、N-乙酰-β-D-氨基葡萄糖苷酶（NAG）和心脏型脂肪酸结合蛋白（H-FABP）的浓度没有差异。第 2 天，SEVO 组的 KIM-1 浓度较高[952.8（四分位距 311.8-1893.0）pg mmol-1]，而 PROP 组为 301.2（202.0-504.7）pg mmol-1。NAG 也是如此：SEVO 组 1.835（1.162-2.457）IU mmol-1 与 PROP 组 1.078（0.819-1.713）IU mmol-1。H-FABP 的浓度没有差异。3、6 和 12 个月时测量的肾小球滤过率没有差异。2 年后，急性排斥反应率有差异（P=0.039）。事后检验显示 PROP（35%）和 PROSE（5%）之间有差异（P=0.020）。PROP 与 SEVO 组（11%）之间的差异无统计学意义（P=0.110）。
在活体供肾移植中，SEVO 组在移植后第二天的尿液 KIM-1 和 NAG 浓度较高。这并没有反映在移植物结局较差。
NCT01248871。
