Detailed Abstract
[E-poster - Liver (Transplantation)]
[EP 020] The effect of desflurane compared to sevoflurane in liver grafts with steatosis in deceased donor liver transplantation for primary liver cirrhosis
Eun-Ki MIN1, Insun PARK2, Deok Gie KIM1, Dong Jin JOO1, Bon-Nyeo KOO3, Jae Geun LEE1
1Department of Surgery, Division of Transplant Surgery, Yonsei University College of Medicine, Republic of Korea, 2Department of Anesthesiology, Seoul National University Bundang Hospital, Republic of Korea, 3Department of Anesthesiology, Yonsei University College of Medicine, Republic of Korea
Background : The effects of desflurane and sevoflurane on liver transplant outcomes, particularly in cases with fatty grafts, remain unknown. This study aimed to analyze the effects of desflurane compared to sevoflurane on graft outcomes in deceased donor liver transplantation (DDLT) for primary liver cirrhosis, with a specific focus on liver grafts with steatosis.
Methods : This retrospective study analyzed 151 patients who underwent DDLT for primary liver cirrhosis between January 2006 and December 2022. Among these patients, 49 received sevoflurane, and 102 received desflurane as a maintenance anesthetic agent. After propensity score matching, the sevoflurane and desflurane groups each comprised 49 patients. Early allograft dysfunction (EAD), five-year graft loss and mortality rates were compared between the two groups based on different macrovesicular steatosis grades of the graft (<10% or ≥10%) and the MELD score (<35 or ≥35) using Kaplan-Meier survival analysis. Independent risk factors for five-year graft loss and mortality were analyzed through multivariable logistic regression analysis.
Results : In the matched population, there was no significant difference in the incidence of EAD between the two groups, regardless of the graft steatosis group. However, when a graft with steatosis ≥10% was used for patients with a MELD score ≥35, the sevoflurane group showed significantly higher five-year graft loss (P=0.025) and five-year mortality (P=0.02) compared to the desflurane group. Multivariable analysis of patients anesthetized with sevoflurane revealed that macrovesicular steatosis ≥10% was associated with increased five-year mortality (odds ratio [OR]: 7.75; 95% confidence interval [CI]: 1.85-37.4; P=0.007) and a non-significant trend towards increased five-year graft loss (OR: 6.75; 95% CI: 0.97-58.2; P=0.054).
Conclusions : The use of sevoflurane as a maintenance agent during DDLT with high MELD scores and fatty grafts may be associated with poorer outcomes. Caution is advised when using sevoflurane for DDLT with fatty liver grafts, and further research through randomized controlled trials is recommended.
Methods : This retrospective study analyzed 151 patients who underwent DDLT for primary liver cirrhosis between January 2006 and December 2022. Among these patients, 49 received sevoflurane, and 102 received desflurane as a maintenance anesthetic agent. After propensity score matching, the sevoflurane and desflurane groups each comprised 49 patients. Early allograft dysfunction (EAD), five-year graft loss and mortality rates were compared between the two groups based on different macrovesicular steatosis grades of the graft (<10% or ≥10%) and the MELD score (<35 or ≥35) using Kaplan-Meier survival analysis. Independent risk factors for five-year graft loss and mortality were analyzed through multivariable logistic regression analysis.
Results : In the matched population, there was no significant difference in the incidence of EAD between the two groups, regardless of the graft steatosis group. However, when a graft with steatosis ≥10% was used for patients with a MELD score ≥35, the sevoflurane group showed significantly higher five-year graft loss (P=0.025) and five-year mortality (P=0.02) compared to the desflurane group. Multivariable analysis of patients anesthetized with sevoflurane revealed that macrovesicular steatosis ≥10% was associated with increased five-year mortality (odds ratio [OR]: 7.75; 95% confidence interval [CI]: 1.85-37.4; P=0.007) and a non-significant trend towards increased five-year graft loss (OR: 6.75; 95% CI: 0.97-58.2; P=0.054).
Conclusions : The use of sevoflurane as a maintenance agent during DDLT with high MELD scores and fatty grafts may be associated with poorer outcomes. Caution is advised when using sevoflurane for DDLT with fatty liver grafts, and further research through randomized controlled trials is recommended.
SESSION
E-poster
E-Session 03/21 ALL DAY