Effects of Desflurane versus sevoflurane on graft outcome of patients with cirrhosis receiving steatotic liver graft in deceased donor liver transplantation.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 8812166 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4529 (Electronic) Linking ISSN: 09528180 NLM ISO Abbreviation: J Clin Anesth Subsets: MEDLINE
    • Publication Information:
      Publication: <2008->: New York : Elsevier
      Original Publication: [Stoneham, MA] : Butterworths, [c1988-
    • Subject Terms:
      Desflurane*/administration & dosage ; Desflurane*/adverse effects ; Sevoflurane*/administration & dosage ; Liver Transplantation*/adverse effects ; Liver Cirrhosis*/complications ; Liver Cirrhosis*/surgery ; Liver Cirrhosis*/mortality ; Anesthetics, Inhalation*/administration & dosage ; Anesthetics, Inhalation*/adverse effects ; Fatty Liver* ; Graft Survival*/drug effects; Humans ; Male ; Female ; Middle Aged ; Retrospective Studies ; Adult ; Treatment Outcome ; Graft Rejection/prevention & control ; Propensity Score ; Republic of Korea/epidemiology
    • Abstract:
      Study Objective: This study aimed to analyze the effects of two volatile anesthetic agents, desflurane and sevoflurane, on graft outcomes in patients undergoing deceased donor liver transplantation (DDLT) for cirrhosis, with a specific focus on fatty grafts.
      Design: A retrospective observational study.
      Setting: A tertiary hospital (Severance Hospital, Korea).
      Patients: This study included 151 patients with liver cirrhosis who underwent DDLT for cirrhosis between January 2006 and December 2022.
      Interventions: Patients were grouped according to maintenance anesthesia received (desflurane or sevoflurane), the model for end-stage liver disease (MELD) score, and macrovesicular steatosis (MVS) of the liver graft.
      Measurements: Survival curves were constructed from the date of surgery to graft failure or death. After propensity score matching (PSM), Cox regression analysis was used to compare hazards ratios (HR) for 5-year graft and overall survival. Subgroup analyses were performed for the MELD score and MVS of the liver graft. Incidences of 1-month acute rejection and early allograft dysfunction (EAD) were also compared between the two groups.
      Main Results: Among 151 eligible patients, 49 patients remained in each group after PSM, with 14 (28.6 %) graft failures and deaths occurring in each group. In matched analysis, sevoflurane showed poorer 5-year graft and overall survival compared to desflurane in recipients of graft with ≥10 % MVS, and this trend was significant in patients with MELD score of ≥35. In Cox regression model, compared to desflurane sevoflurane showed a propensity score-matched HR of 5.8 (95 % CI, 1.13-30.50 for both 5-year graft and overall survival. Additionally, sevoflurane showed an increased risk of 1-month acute rejection; however, no difference was observed for EAD.
      Conclusions: Sevoflurane as a maintenance agent during DDLT in recipients with high MELD scores and fatty grafts may be associated with poorer outcomes compared to desflurane.
      Competing Interests: Declaration of competing interest None.
      (Copyright © 2024 Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Desflurane; Fatty liver; Liver cirrhosis; Liver transplantation; Reperfusion injury; Sevoflurane
    • Accession Number:
      CRS35BZ94Q (Desflurane)
      38LVP0K73A (Sevoflurane)
      0 (Anesthetics, Inhalation)
    • Publication Date:
      Date Created: 20241110 Date Completed: 20241124 Latest Revision: 20241124
    • Publication Date:
      20241126
    • Accession Number:
      10.1016/j.jclinane.2024.111674
    • Accession Number:
      39522255