Effects of Desflurane versus sevoflurane on graft outcome of patients with cirrhosis receiving steatotic liver graft in deceased donor liver transplantation

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2024-11-09 DOI:10.1016/j.jclinane.2024.111674

Insun Park , Eun-Ki Min , Bon-Nyeo Koo , Jae Hyon Park , Deok Gie Kim , Dong Jin Joo , Jae Geun Lee

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Abstract

Study objective

This study aimed to analyze the effects of two volatile anesthetic agents, desflurane and sevoflurane, on graft outcomes in patients undergoing deceased donor liver transplantation (DDLT) for cirrhosis, with a specific focus on fatty grafts.

Design

A retrospective observational study.

Setting

A tertiary hospital (Severance Hospital, Korea).

Patients

This study included 151 patients with liver cirrhosis who underwent DDLT for cirrhosis between January 2006 and December 2022.

Interventions

Patients were grouped according to maintenance anesthesia received (desflurane or sevoflurane), the model for end-stage liver disease (MELD) score, and macrovesicular steatosis (MVS) of the liver graft.

Measurements

Survival curves were constructed from the date of surgery to graft failure or death. After propensity score matching (PSM), Cox regression analysis was used to compare hazards ratios (HR) for 5-year graft and overall survival. Subgroup analyses were performed for the MELD score and MVS of the liver graft. Incidences of 1-month acute rejection and early allograft dysfunction (EAD) were also compared between the two groups.

Main results

Among 151 eligible patients, 49 patients remained in each group after PSM, with 14 (28.6 %) graft failures and deaths occurring in each group. In matched analysis, sevoflurane showed poorer 5-year graft and overall survival compared to desflurane in recipients of graft with ≥10 % MVS, and this trend was significant in patients with MELD score of ≥35. In Cox regression model, compared to desflurane sevoflurane showed a propensity score-matched HR of 5.8 (95 % CI, 1.13–30.50 for both 5-year graft and overall survival. Additionally, sevoflurane showed an increased risk of 1-month acute rejection; however, no difference was observed for EAD.

Conclusions

Sevoflurane as a maintenance agent during DDLT in recipients with high MELD scores and fatty grafts may be associated with poorer outcomes compared to desflurane.

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地氟醚与七氟醚对接受脂肪肝肝移植的肝硬化患者移植结果的影响

研究目的本研究旨在分析地氟醚和七氟醚这两种挥发性麻醉剂对肝硬化死亡供体肝移植（DDLT）患者移植物预后的影响，尤其关注脂肪移植物：设计：回顾性观察研究：患者：151名肝硬化患者：本研究纳入了2006年1月至2022年12月期间接受DDLT治疗的151例肝硬化患者：根据接受的维持麻醉（地氟醚或七氟醚）、终末期肝病模型（MELD）评分和肝脏移植物大泡性脂肪变性（MVS）对患者进行分组：测量：构建了从手术日期到移植失败或死亡的生存曲线。经过倾向评分匹配（PSM）后，采用Cox回归分析比较5年移植物和总生存率的危险比（HR）。根据肝脏移植物的 MELD 评分和 MVS 进行了分组分析。还比较了两组患者 1 个月急性排斥反应和早期异体移植功能障碍（EAD）的发生率：主要结果：在 151 名符合条件的患者中，每组有 49 名患者在 PSM 后继续接受治疗，每组均有 14 例（28.6%）移植失败和死亡。在匹配分析中，与地氟醚相比，七氟醚在MVS≥10%的移植物受者中显示出更差的5年移植物和总生存率，这一趋势在MELD评分≥35分的患者中显著。在 Cox 回归模型中，与地氟醚相比，七氟醚在 5 年移植物存活率和总存活率方面的倾向评分匹配 HR 为 5.8（95 % CI，1.13-30.50）。此外，七氟醚增加了1个月急性排斥反应的风险；但在EAD方面未观察到差异：结论：与地氟烷相比，七氟烷作为 MELD 评分高和脂肪移植物受者 DDLT 期间的维持用药可能会导致较差的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.