Transplant Trial Watch

Effect of sevoflurane and propofol on acute kidney injury in pediatric living donor liver transplantation.

Li, H., Weng, Y. et al. (2019).

Annals of Translational Medicine 7(14): 340.


Aims
This study aimed to compare the effects of propofol and sevoflurane anesthetics on postoperative acute kidney injury (AKI) after liver transplantation (LT) surgery.

Interventions
Patients enrolled in this study were randomly assigned to pediatric related LT with either intravenous anesthetic propofol or volatile anesthetic sevoflurane.

Participants
A total of 120 pediatric patients (aged 5 months–2 years; and American Society of Anesthesiologist physical status III to IV) scheduled for pediatric LT were enrolled into this study.

Outcomes
The primary outcome was incidence of AKI, and was defined as any stage of AKI according to the Kidney Disease: Improving Global Outcomes guidelines; increase in serum creatinine by ≥0.3 mg/dL (≥26.5 µmol/L) within 48 hours; or increase in serum creatinine of ≥1.5 times than that of the baseline, which is known or presumed to have occurred within or prior to 3 days; or urine volume of <0.5 mL/kg/hour for 6 hours.

Follow-up
Median of 0.8 years

CET Conclusions
At first reading this is a moderate to good quality randomised controlled trial in live donor paediatric liver transplantation. The study was adequately randomised and had a reasonable power calculation to advise the sample size. The patients were blinded to their group allocation, but the clinicians were not. It is a bit odd that for 12 patients the primary outcome could not be assessed because there were no preoperative or post-operative serum creatinine results available, and so they were excluded from analysis. The study showed a significant reduction in AKI (using KDIGO definition) from 47% to 28%, favouring sevoflurane compared to propofol, a quite drastic effect. The statistical significance of this result might have been considerably altered if results from the excluded patients had been available. There were some differences in inflammatory markers, notably lower levels of IL-18, TNF-alpha and NGAL in the sevoflurane group at some time points after surgery. There were no significant differences in the markers of oxidative stress tested in the study (SOD, MDA, H202). If the results of this study are to be believed, then sevoflurane provided a lower relative risk for post-operative AKI of 0.6 compared to propofol, an absolute risk reduction of 19% in this particular population. With the missing data the significant result should be viewed with caution.

Jadad score
3

Data analysis
Per protocol analysis

Allocation concealment
Yes

Trial registration
N/A

Funding source
Non-industry funded