Effect of sevoflurane on grafted kidney function in renal transplantation

Background and Aims:The perioperative management of patients presenting for simultaneous liver and kidney transplantation (SLKT) is a complex process. We analysed SLKTs performed in our institution to identify preoperative, intraoperative and post-operative challenges encountered in the management.Methods:We retrospectively studied the case records of 12 patients who underwent SLKT between 2009 and 2014 and analysed details of pre-operative evaluation and optimisation, intraoperative anaesthetic management and the implications of use of perioperative continuous renal replacement therapy (CRRT) and the post-operative course of these patients.Results:Of the total 12 cases, 4 were under 16 years of age. The indications for SLKT were primary hyperoxaluria (5), congenital hepatic fibrosis with polycystic kidney disease (2), ethanol-related end-stage liver disease (ESLD) with hepatorenal syndrome type 1 (1). Four patients had ESLD with end-stage renal disease due to other causes. Six recipients received live donor grafts and 6 patients received cadaveric grafts. Seven patients received intraoperative CRRT. Mean duration of surgery was 12.5 h. Cardiac output monitors used were trans-oesophageal echocardiogram (2), pulmonary artery catheter (1) and pulse contour cardiac output monitor (3). There was 1 sepsis-related mortality on 7th post-operative day.Conclusion:A thorough pre-operative evaluation and optimisation, knowledge and anticipation of potential problems, and meticulous intraoperative fluid management guided by appropriate monitoring and use of CRRT when needed can help in achieving successful outcomes.

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“…[ 24 ] The choice of inhalational anaesthetic agent has not shown to affect any of the outcomes in the renal transplant recipients. [ 25 26 ]…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients

Rajakumar¹,

Gupta²,

Malleeswaran³

et al. 2016

Indian J Anaesth

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“…In 2007, the European Medicines and Products Regulatory Agency recommends vigilance in using Penelon Sigma Delta vapourisers and withdrawn it from use, due to the interaction of sevoflurane with Lewis acids [6,7]. Currently there are 3 forms of sevoflurane, with differences in terms of the production process, but without physical-chemical differences [8] There are authors who support the use of sevoflurane in patients with renal disorder, renal transplantation [9], in anesthesia for interventions of kidney transplantation [10].…”

Section: Discussionmentioning

confidence: 99%

Study on Changes of the Urea, Serum Creatinine and Glomerular Protein Permeability, after General Anesthesia with Sevoflurane

Stoian

Dumitru

et al. 2015

Acta Medica Marisiensis

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Introduction:The widespread use of sevoflurane as an induction and maintenance volatile agent of general anesthesia demostrates an increased safety profile. Sevoflurane contact with CO 2 absorbents lead to the occurrence of toxic compounds such as Compund A and Compound B . Among the side efffects of Sevoflurane remember the renal toxic effect much discussed in the literature but still unresolved. In previous research we have demonstrated the glomerular protein changes as a result of exposure to Sevoflurane. In the current study we intend to monitor the changes in blood urea nitrogen and serum creatinine after exposure to Sevoflurane. Material and method: We included in our study 90 patients who were anesthetized in the Department of Anesthesiology of the County Mure Hospital during 01.10.2009-01.10.2014. They had normal values for blood urea nitrogen and serum creatinine and had no preoperative proteinuria. Serum and urine samples were taken preoperatively and at 24 and 72 hours postanesthetic and were analyzed in the laboratory. Proteinuria was determined by spectrophotometry. Results: After protein quantitative determination by spectrophotometry and statistical anaysis we obtained significant differences by comparing the average preoperative/24 hours total protein (p<0.0001) and 24/72 hours (p<0.0001). There are no significant statistical differences by comparing the blood urea nitrogen at the three intervals (p<0.53) and no statistical changes for mean serum creatinine (p<0.18). Conclusions: Changes in glomerular filtered proteins following exposure to Sevoflurane demonstrate its toxic effect on glomerular tubules. Lack of perioperative significant wich is why we recommend determining perioperative urinary protein as a marker of glomerular damage.

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“…No difference was found between the two groups. In another retrospective study, the effects of sevofl urane (n= 73) and desfl urane (n= 71) were compared at postoperative 1st year [19]. Creatinine, BUN levels and glomerular fi ltration rate didnot differ between groups.…”

Section: Ideal Volatile Agentmentioning

confidence: 99%

Volatile agents and renal transplantation

Saraçoğlu¹,

Bilgili²,

Saraçoğlu³

2020

Glob J Anesth

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Living donor and cadaveric donor renal transplantation have received a signifi cant interest. During the procedure, both volatile agents and total intravenous anesthesia are used. However, the effects of volatile agents used during anesthesia on primary graft dysfunction is controversial. Besides evidence-based scientifi c data is not enough to conclude the ideal inhalation agent in renal transplantation. This review aimed to determine the effects of volatile agents preventing or improving the Ischemia Reperfusion (IR) injury during general anesthesia in patients undergoing renal transplantation. The possible mechanisms that affect the outcome of the patients after transplantation will be discussed.

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Effect of sevoflurane on grafted kidney function in renal transplantation

Cited by 12 publications

References 29 publications

Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients

Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients

Study on Changes of the Urea, Serum Creatinine and Glomerular Protein Permeability, after General Anesthesia with Sevoflurane

Volatile agents and renal transplantation

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