Date: Tuesday, May 5, 2015
Session Name: Concurrent Session: Kidney: Acute Cellular Rejection
Session Time: 4:00pm-5:30pm
Presentation Time: 5:00pm-5:12pm
Location: Room 121-AB
Volatile anesthetic agents like sevoflurane may protect against the ischemia and reperfusion injury (IRI) that is inevitable part of organ donation and transplantation. It is also increasingly recognised that volatile anaesthetics modify immune cell functions via several mechanisms. This could have great potential for organ transplantation. Our group set out to optimize the anesthetic regimen in renal transplant recipients. In this trial we evaluated the influence of two common anaesthetic regimens, a propofol based anesthesia vs. a sevoflurane based anesthesia, on transplant outcome in living donor kidney transplantation (LDKT). We considered LDKT as the ideal first step as it is a standardized, controlled, procedure with reproducible cold and warm ischemic periods, the possibility to precondition both donor and recipient and the absence of profound systemic changes found in postmortal donors.
In a prospective randomized controlled clinical trial 60 couples were assigned to three groups: PROP; donor and recipient received propofol, SEVO; donor and recipient received sevoflurane and SERE; donor received propofol and recipient received sevoflurane (n=20/group). Only left kidneys were included because of the presence of the gonadal vein as a side branch through which blood samples during reperfusion could be taken. Blood and urine samples were taken at different time points. Renal biopsies were taken during cold ischemia and 1 hour after reperfusion.
There were no significant differences in demographic characteristics between groups. Acute rejection after two years: PROP 6/17 (35,3%), SEVO 2/19 (10,5%) and SERE 1/20 (5,0%). There was a significant reduction in acute rejection in SERE vs PROP (Fisher exact, p=0.033) and when SERE and SEVO groups were combined (sevoflurane vs propofol for recipients) difference in acute rejection was even stronger 3/39 (7,7%) in sevoflurane recipients vs 6/17 (35%) in propofol recipients, Fisher exact , p=0.017.
A sevoflurane based anesthesia significantly reduces acute rejection within 2 years following living donor kidney transplantation. This is a remarkable finding which needs to be further investigated in kidney transplantation with postmortal donors
To cite this abstract in AMA style:Nieuwenhuijs-Moeke G, Nieuwenhuijs V, Seelen M, Ploeg R, Leuvenink H, Struys M. Sevoflurane Based Anesthesia in Recipients Reduces 2 Year Acute Rejection in Living Donor Kidney Transplantation. Results from the VAPOR-Trial [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/sevoflurane-based-anesthesia-in-recipients-reduces-2-year-acute-rejection-in-living-donor-kidney-transplantation-results-from-the-vapor-trial/. Accessed November 29, 2020.
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