From the Department of Anesthesiology and Pain Medicine, Severance Hospital (SS, MIB, EH, YCY), Anesthesia and Pain Research Institute, Yonsei University College of Medicine (SS, MIB, EH, J-SL, YCY), Department of Surgery, Yonsei University College of Medicine (DJJ, MSK), Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Seoul (J-SL) and Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea (DWK).
Eur J Anaesthesiol. 2019 Sep;36(9):656-666. doi: 10.1097/EJA.0000000000001018.
Propofol is an anaesthetic that resembles α-tocopherol and it has been suggested that it protects against ischaemia-reperfusion injury in liver transplantation. Living-donor liver transplantation (LDLT) presents an opportunity to test this hypothesis in both donors and recipients.
We compared clinical outcomes after LDLT following anaesthesia with propofol and desflurane against desflurane alone.
A randomised, parallel study.
Single-centre trial, study period June 2014 and May 2017.
Sixty-two pairs of adult donors and recipients who underwent LDLT.
Patients were randomised to receive either desflurane balanced anaesthesia or propofol total intravenous anaesthesia combined with desflurane anaesthesia.
The primary outcome was peak liver transaminase levels during the first 7 days after surgery. Liver function was assessed at 10 different time-points (before surgery, 1 h after reperfusion, upon arrival in the ICU, and daily until postoperative day 7). Creatinine was measured to evaluate the incidence of acute kidney injury. TNF-α, IL-1β, IL-6 and TGF-β1 were assessed in 31 donors after induction, at hepatectomy and at the end of surgery and in 52 recipients after induction, and 1, 3 and 24 h after reperfusion.
Peak liver transaminase levels were not significantly different between the two groups. Liver function tests and creatinine were also similar between groups at all time-points. There was no difference in the incidence of postoperative complications, including acute kidney injury. With the exception of higher TNF-α in donors of the Propofol group at hepatectomy (0.60 ± 0.29 vs. 1.03 ± 0.53, P = 0.01) cytokine results were comparable between the two groups.
Despite the simultaneous administration of propofol infusion in both donors and recipients, no improvement in laboratory or surgical outcome was observed after LDLT compared with patients who received desflurane anaesthesia alone.
NCT02504138 at clinicaltrials.gov.
丙泊酚是一种类似α-生育酚的麻醉剂，有人提出它可以防止肝移植中的缺血再灌注损伤。活体供肝移植（LDLT）为在供体和受体中检验这一假说提供了机会。
我们比较了使用丙泊酚和地氟醚进行麻醉与单独使用地氟醚进行 LDLT 后的临床结果。
随机、平行研究。
单中心试验，研究期间为 2014 年 6 月至 2017 年 5 月。
62 对接受 LDLT 的成年供体和受体。
患者随机接受地氟醚平衡麻醉或丙泊酚全静脉麻醉联合地氟醚麻醉。
主要结局是术后 7 天内的谷丙转氨酶峰值。肝功能在 10 个不同时间点进行评估（术前、再灌注后 1 小时、到达 ICU 时以及术后第 1 天至第 7 天每天）。测量肌酐以评估急性肾损伤的发生率。在诱导后、肝切除时和手术结束时评估 31 名供体以及在诱导后、再灌注后 1、3 和 24 小时评估 52 名受体中的 TNF-α、IL-1β、IL-6 和 TGF-β1。
两组间谷丙转氨酶峰值无显著差异。两组在所有时间点的肝功能检查和肌酐也相似。术后并发症的发生率，包括急性肾损伤，两组间无差异。除了丙泊酚组供体在肝切除时 TNF-α较高（0.60±0.29 比 1.03±0.53，P=0.01）外，两组间细胞因子结果相似。
尽管同时在供体和受体中输注丙泊酚，但与单独使用地氟醚麻醉的患者相比，LDLT 后实验室或手术结果未见改善。
NCT02504138 于 clinicaltrials.gov。
