Propofol TIVA anesthesia does not reduce hepatic reperfusion injury after liver transplant when compared to desflurane anesthesia.

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• Seokyung Shin, Dong J Joo, Myoung S Kim, Myung I Bae, Eunjin Heo, Jong-Seok Lee, Dong W Kim, and Young C Yoo.
• From the Department of Anesthesiology and Pain Medicine, Severance Hospital (SS, MIB, EH, YCY), Anesthesia and Pain Research Institute, Yonsei University College of Medicine (SS, MIB, EH, J-SL, YCY), Department of Surgery, Yonsei University College of Medicine (DJJ, MSK), Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Seoul (J-SL) and Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea (DWK).
• Eur J Anaesthesiol. 2019 Sep 1; 36 (9): 656-666.

BackgroundPropofol is an anaesthetic that resembles α-tocopherol and it has been suggested that it protects against ischaemia-reperfusion injury in liver transplantation. Living-donor liver transplantation (LDLT) presents an opportunity to test this hypothesis in both donors and recipients.ObjectivesWe compared clinical outcomes after LDLT following anaesthesia with propofol and desflurane against desflurane alone.DesignA randomised, parallel study.SettingSingle-centre trial, study period June 2014 and May 2017.PatientsSixty-two pairs of adult donors and recipients who underwent LDLT.InterventionPatients were randomised to receive either desflurane balanced anaesthesia or propofol total intravenous anaesthesia combined with desflurane anaesthesia.Main Outcome MeasuresThe primary outcome was peak liver transaminase levels during the first 7 days after surgery. Liver function was assessed at 10 different time-points (before surgery, 1 h after reperfusion, upon arrival in the ICU, and daily until postoperative day 7). Creatinine was measured to evaluate the incidence of acute kidney injury. TNF-α, IL-1β, IL-6 and TGF-β1 were assessed in 31 donors after induction, at hepatectomy and at the end of surgery and in 52 recipients after induction, and 1, 3 and 24 h after reperfusion.ResultsPeak liver transaminase levels were not significantly different between the two groups. Liver function tests and creatinine were also similar between groups at all time-points. There was no difference in the incidence of postoperative complications, including acute kidney injury. With the exception of higher TNF-α in donors of the Propofol group at hepatectomy (0.60 ± 0.29 vs. 1.03 ± 0.53, P = 0.01) cytokine results were comparable between the two groups.ConclusionDespite the simultaneous administration of propofol infusion in both donors and recipients, no improvement in laboratory or surgical outcome was observed after LDLT compared with patients who received desflurane anaesthesia alone.Trial RegistrationNCT02504138 at clinicaltrials.gov.

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