Comparison of the Effects of Sevoflurane and Isoflurane During Liver Transplant Surgery on the Short-Term Cardiac, Hepatic, and Renal Outcome: A Randomized Clinical Trial.

Abstract

Background: Liver transplantation is frequently complicated by ischemia-reperfusion injury (IRI), which may impair hepatic, renal, and cardiac function. Volatile anesthetics such as isoflurane and sevoflurane are believed to mitigate this injury.

Objectives: This study aimed to compare their effects on short-term organ outcomes in deceased donor liver transplant recipients.

Methods: In this study, 70 liver transplantation candidates at Taleghani Hospital in Tehran were enrolled after obtaining informed consent, and various variables were assessed before, during, and at two intervals immediately after surgery and one week post-operation. Patients were randomly allocated to receive either isoflurane or sevoflurane for anesthesia maintenance using the sealed opaque envelope technique for allocation concealment. Randomization was performed by a study nurse not involved in patient care using computer-generated random numbers. The primary outcome was defined as the postoperative peak serum alanine aminotransferase (ALT) level. Secondary outcomes included peak aspartate aminotransferase (AST), total bilirubin, creatinine, troponin I, C-reactive protein (CRP), intraoperative blood product requirements (packed red blood cells and fresh frozen plasma), hemodynamic parameters, and urine output.

Results: Baseline characteristics were comparable between groups. No significant differences were found in intraoperative hemodynamics or postoperative laboratory values of liver and renal function (P > 0.05). Postoperative liver enzyme levels increased in both groups following reperfusion, consistent with IRI. However, no statistically significant differences were observed between the isoflurane and sevoflurane groups in peak serum ALT levels, measured 6 hours after reperfusion and on postoperative day 7 (P > 0.05 for all comparisons). Similarly, AST levels did not differ significantly between groups at any postoperative time point. Renal and cardiac biomarkers, including creatinine and troponin I, were also comparable between groups. In contrast, patients receiving sevoflurane required significantly higher volumes of packed red blood cells and fresh frozen plasma intraoperatively compared with the isoflurane group (P < 0.05).

Conclusions: The results obtained in this study showed that the use of isoflurane and sevoflurane did not have a significant difference in the severity of ischemic reperfusion injury caused after liver transplantation surgery on the liver, kidney, and heart; also, in this study, the functional conditions of these organs during and after surgery were evaluated, and by examining at different time intervals, these two inhalation anesthetics did not have a different effect on the short-term outcome of patients after receiving a liver transplant.