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.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:87679 |
| Date | 26 October 2023 |
| Creators | Jahn, Nora, Völker, Maria Theresa, Laudi, Sven, Stehr, Sebastian, Schneeberger, Stefan, Brandacher, Gerald, Sucher, Elisabeth, Rademacher, Sebastian, Seehofer, Daniel, Hau, Hans Michael, Sucher, Robert |
| Publisher | MDPI |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 3385 |
Page generated in 0.0103 seconds