Conditioning With Sevoflurane in Liver Transplantation: Results of a Multicenter Randomized Controlled Trial
Beck-Schimmer B J, Bonvini M, et al.Transplantation 2015 Aug;99(8):1606-12
Aims
To examine if volatile anesthetics have an effect on acute graft injury and clinical outcomes after liver transplantation.
Interventions
Sevoflurane anesthesia versus propofol
Participants
98 liver transplant recipients randomised to propofol (n = 48) or sevoflurane (n = 50)
Outcomes
The primary endpoint was postoperative peak of aspartate transaminase. Secondary endpoints included; early allograft dysfunction, in-hospital complications, and intensive care unit and hospital stay.
Follow-up
7 days
CET Conclusions
This paper compared sevoflurane to propofol anaesthesia in liver transplant recipients in a well conducted study. The primary end-point was peak serum aspartate transaminase (AST) in the first week after transplantation. There was a very large number of patients excluded from the study due to enrolment in another study (113 out of 343 assessed). Of those that were randomised, a relatively small number did not proceed to transplantation, and these were equally spread between the two arms. One patient in each arm received the other treatment due to anaesthetist’s concern and these were analysed by intention-to-treat. There was no significant difference in the primary or secondary outcomes. The authors discussed the requirement for much larger numbers of patients if a clinical outcome had been used rather than a biochemical surrogate. However, this is still no guarantee that a significant difference would have been found.
Data analysis
Modified intention-to-treat analysis
Trial registration
Clinicaltrials.gov - NCT00913276