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Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation

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 transpl...

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Autores principales: Jahn, Nora, Völker, Maria Theresa, Laudi, Sven, Stehr, Sebastian, Schneeberger, Stefan, Brandacher, Gerald, Sucher, Elisabeth, Rademacher, Sebastian, Seehofer, Daniel, Hau, Hans Michael, Sucher, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9225086/
https://www.ncbi.nlm.nih.gov/pubmed/35743457
http://dx.doi.org/10.3390/jcm11123385
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author Jahn, Nora
Völker, Maria Theresa
Laudi, Sven
Stehr, Sebastian
Schneeberger, Stefan
Brandacher, Gerald
Sucher, Elisabeth
Rademacher, Sebastian
Seehofer, Daniel
Hau, Hans Michael
Sucher, Robert
author_facet Jahn, Nora
Völker, Maria Theresa
Laudi, Sven
Stehr, Sebastian
Schneeberger, Stefan
Brandacher, Gerald
Sucher, Elisabeth
Rademacher, Sebastian
Seehofer, Daniel
Hau, Hans Michael
Sucher, Robert
author_sort Jahn, Nora
collection PubMed
description 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.
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spelling pubmed-92250862022-06-24 Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation Jahn, Nora Völker, Maria Theresa Laudi, Sven Stehr, Sebastian Schneeberger, Stefan Brandacher, Gerald Sucher, Elisabeth Rademacher, Sebastian Seehofer, Daniel Hau, Hans Michael Sucher, Robert J Clin Med Article 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. MDPI 2022-06-13 /pmc/articles/PMC9225086/ /pubmed/35743457 http://dx.doi.org/10.3390/jcm11123385 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jahn, Nora
Völker, Maria Theresa
Laudi, Sven
Stehr, Sebastian
Schneeberger, Stefan
Brandacher, Gerald
Sucher, Elisabeth
Rademacher, Sebastian
Seehofer, Daniel
Hau, Hans Michael
Sucher, Robert
Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation
title Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation
title_full Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation
title_fullStr Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation
title_full_unstemmed Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation
title_short Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation
title_sort analysis of volatile anesthetic-induced organ protection in simultaneous pancreas–kidney transplantation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9225086/
https://www.ncbi.nlm.nih.gov/pubmed/35743457
http://dx.doi.org/10.3390/jcm11123385
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