Molecular Aspects of Volatile Anesthetic-Induced Organ Protection and Its Potential in Kidney Transplantation

Nieuwenhuijs-Moeke, Gertrude J.; Bosch, Dirk; Leuvenink, Henri

doi:10.3390/ijms22052727

Cited by 9 publications

(5 citation statements)

References 186 publications

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“…Results from our study, which investigated the effects of three different VAs during general anesthesia in patients receiving a simultaneous pancreas and kidney transplantation (SPKT), are in line with previous findings obtained in the kidney [ 2 , 7 , 38 ], liver [ 6 ], and pancreas [ 9 ] transplant recipients. Anesthesia with sevoflurane and desflurane demonstrated graft protecting qualities by reducing IRI-associated postoperative complications.…”

Section: Discussionsupporting

confidence: 91%

“…This is particularly attributed to the volatile anesthetics (VA) used in our study and, to a lesser extent, to intravenous anesthetic agents [ 41 , 42 ]. With regard to the transplant setting, beneficial effects of VAs on IRI-associated consequences and improved graft outcomes could mainly be demonstrated in patients receiving a kidney or liver transplantation, with comparatively small differences between the study groups and also showing relatively short-lived and early improvements [ 2 , 6 , 7 , 8 , 38 ]. More recently, a study by Atoa et al demonstrated the protective effects of desflurane and sevoflurane compared with isoflurane in the first phase after SPKT, which were in line with our findings [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the reperfusion phase during surgery especially offers an auspicious window of opportunity to mitigate IRI and improve short- and long-term outcomes. In this context, volatile anesthetics (VA) have been shown to interfere with many pathophysiological mechanisms contributing to the injurious cascade of IRI [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…One interesting possibility that may attenuate IRI by inducing biochemical changes in different tissues seems to be pharmacological conditioning [ 2 , 7 ]. Herein, the administration of VAs has been shown to be effective in providing cellular tolerance against IRI in various tissues and organs, including the heart, brain, kidney, liver, and lung [ 3 , 6 , 7 , 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation

Jahn

Völker

Laudi

et al. 2022

JCM

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Background: Despite recent advances in surgical procedures and immunosuppressive regimes, early pancreatic graft dysfunction, mainly specified as ischemia–reperfusion injury (IRI)—Remains a common cause of pancreas graft failure with potentially worse outcomes in simultaneous pancreas-kidney transplantation (SPKT). Anesthetic conditioning is a widely described strategy to attenuate IRI and facilitate graft protection. Here, we investigate the effects of different volatile anesthetics (VAs) on early IRI-associated posttransplant clinical outcomes as well as graft function and outcome in SPKT recipients. Methods: Medical data of 105 patients undergoing SPKT between 1998–2018 were retrospectively analyzed and stratified according to the used VAs. The primary study endpoint was the association and effect of VAs on pancreas allograft failure following SPKT; secondary endpoint analyses included “IRI- associated posttransplant clinical outcome” as well as long-term graft function and outcome. Additionally, peak serum levels of C-reactive protein (CRP) and lipase during the first 72 h after SPKT were determined and used as further markers for “pancreatic IRI” and graft injury. Typical clinicopathological characteristics and postoperative outcomes such as early graft outcome and long-term function were analyzed. Results: Of the 105 included patients in this study three VAs were used: isoflurane (n = 58 patients; 55%), sevoflurane (n = 22 patients; 21%), and desflurane (n = 25 patients, 24%). Donor and recipient characteristics were comparable between both groups. Early graft loss within 3 months (24% versus 5% versus 8%, p = 0.04) as well as IRI-associated postoperative clinical complications (pancreatitis: 21% versus 5% versus 5%, p = 0.04; vascular thrombosis: 13% versus 0% versus 5%; p = 0.09) occurred more frequently in the Isoflurane group compared with the sevoflurane and desflurane groups. Anesthesia with sevoflurane resulted in the lowest serum peak levels of lipase and CRP during the first 3 days after transplantation, followed by desflurane and isoflurane (p = 0.039 and p = 0.001, respectively). There was no difference with regard to 10-year pancreas graft survival as well as endocrine/metabolic function among all three VA groups. Multivariate analysis revealed the choice of VAs as an independent prognostic factor for graft failure three months after SPKT (HR 0.38, 95%CI: 0.17–0.84; p = 0.029). Conclusions: In our study, sevoflurane and desflurane were associated with significantly increased early graft survival as well as decreased IRI-associated post-transplant clinical outcomes when compared with the isoflurane group and should be the focus of future clinical studies evaluating the positive effects of different VA agents in patients receiving SPKT.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation

Jahn

Völker

Laudi

et al. 2022

JCM

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“…Levels of hyaluronan increased significantly over time in the S-EVLP group but did not in the EVLP group. Hyaluronan is an important component of the extracellular matrix and one of the compounds of the glycocalyx, from which it can be released upon IRI or oxidative stress [35]. In an experimental set up with ex vivo perfusion of guinea pig hearts, treatment with sevoflurane showed a protective effect on glycocalyx integrity [24,25].…”

Section: Discussionmentioning

confidence: 99%

Ex Vivo Optimization of Donor Lungs with Inhaled Sevoflurane during Normothermic Ex Vivo Lung Perfusion (VITALISE): A Pilot and Feasibility Study in Sheep

Steinkühler,

Yang,

et al. 2024

IJMS

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Volatile anesthetics have been shown in different studies to reduce ischemia reperfusion injury (IRI). Ex vivo lung perfusion (EVLP) facilitates graft evaluation, extends preservation time and potentially enables injury repair and improvement of lung quality. We hypothesized that ventilating lungs with sevoflurane during EVLP would reduce lung injury and improve lung function. We performed a pilot study to test this hypothesis in a slaughterhouse sheep DCD model. Lungs were harvested, flushed and stored on ice for 3 h, after which EVLP was performed for 4 h. Lungs were ventilated with either an FiO2 of 0.4 (EVLP, n = 5) or FiO2 of 0.4 plus sevoflurane at a 2% end-tidal concentration (Cet) (S-EVLP, n = 5). Perfusate, tissue samples and functional measurements were collected and analyzed. A steady state of the target Cet sevoflurane was reached with measurable concentrations in perfusate. Lungs in the S-EVLP group showed significantly better dynamic lung compliance than those in the EVLP group (p = 0.003). Oxygenation capacity was not different in treated lungs for delta partial oxygen pressure (PO2; +3.8 (−4.9/11.1) vs. −11.7 (−12.0/−3.2) kPa, p = 0.151), but there was a trend of a better PO2/FiO2 ratio (p = 0.054). Perfusate ASAT levels in S-EVLP were significantly reduced compared to the control group (198.1 ± 93.66 vs. 223.9 ± 105.7 IU/L, p = 0.02). We conclude that ventilating lungs with sevoflurane during EVLP is feasible and could be useful to improve graft function.

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Klinischer Stellenwert der perioperativen Organprotektion

Göbel

2022

Anaesthesiologie

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Molecular Aspects of Volatile Anesthetic-Induced Organ Protection and Its Potential in Kidney Transplantation

Cited by 9 publications

References 186 publications

Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation

Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation

Ex Vivo Optimization of Donor Lungs with Inhaled Sevoflurane during Normothermic Ex Vivo Lung Perfusion (VITALISE): A Pilot and Feasibility Study in Sheep

Klinischer Stellenwert der perioperativen Organprotektion

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