Background:
In end stage renal failure, kidney transplantation is the preferred treatment. Because of the remaining shortage of suitable transplants, older, more marginal donors are accepted for donation, which have significantly worse primary function. Anesthetic agents could be the next step in improving transplant outcome. Inevitably, organs suffer from ischemia and reperfusion injury during the procedure of transplantation. The cytokine dominating ischemia and reperfusion injury is interleukin 6. Volatile anesthetics are known to diminish ischemia and reperfusion injury in the human heart and in vivo in the kidney by pre- and postconditioning. Diminishing ischemia and reperfusion injury in living donor kidney transplantation might be a first step in improving transplant outcome in post mortal donors.
Our aim was to determine if volatile anaesthetics have an effect on the release of IL-6 during the first 30 minutes of reperfusion in living donor kidney donation.
Methods:
18 subjects, receiving a left living donor kidney transplantation in the period between September 2010 and april 2011, were divided into three groups depending on anesthetic regime. We compared two widely used anesthetics: propofol and sevoflurane. Group Propofol (PROP) received solely intravenous anaesthesia, group Sevoflurane (SEVO) received volatile anaesthetics and in group Sevoflurane Recipient (SERE) the donor was given intravenous anaesthesia and the recipient received volatile anaesthesia. We measured plasma concentrations of IL-6 during the first 30 minutes of reperfusion systemically (arterial) and directly from the transplanted kidney (venous) by Enzyme-Linked Immuno Sorbent Assay.
Results:
Low IL-6 levels were found in the postconditioning group (SERE). High IL-6 levels were found in the intravenous group (PROP). Transrenal values were the highest in the group receiving sevoflurane throughout the whole procedure (SEVO). Overall creatinine levels were the lowest in group SERE. No complications, delayed graft function or acute rejection were observed in group SERE. Group PROP demonstrated the highest rate of delayed graft function, most complications and the longest hospital stay.
None of these differences were significant.
Conclusion:
No significant relation was found between IL-6 and anesthetic regime. The results suggest a light trend towards postconditioning but this might be due to older age in this group.
