%0 Journal Article
%T The Influence of Pharmacological Preconditioning with Sevoflurane on Incidence of Early Allograft Dysfunction in Liver Transplant Recipients
%A Andrei F. Minou
%A Alexander M. Dzyadzko
%A Aliaksei E. Shcherba
%A Oleg O. Rummo
%J Anesthesiology Research and Practice
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/930487
%X Background. Pharmacological preconditioning is one of the tools used to diminish preservation injury. We investigated the influence of sevoflurane preconditioning of liver grafts on postoperative graft function. Methods. Consecutive 60 deceased brain donors were randomized into sevoflurane group or control group. In sevoflurane group donors were treated with endexpiratory 2,0 volume% of sevoflurane during procurement. Primary endpoint was postoperative liver injury. Secondary endpoint was incidence of early allograft dysfunction (EAD). Results. The groups were not different in median DRI, donor age, graft steatosis, and MELD score. Peak AST and ALT levels were lower in sevoflurane group than in control group: 792 and 1861 ( ) for AST and 606 and 1191 for ALT ( ). Incidence of EAD was 16,7% in sevoflurane group and 50% in control group (Fisher test, ). In subgroups without steatosis preconditioning with sevoflurane did not have influence on incidence of EAD. In subgroups with mild and moderate steatosis incidence of EAD was lower in recipients of liver grafts treated with sevoflurane. Conclusions. Preconditioning with sevoflurane during organ procurement improves graft function by lowering incidence of early allograft dysfunction, particularly in recipients of steatotic liver grafts. 1. Introduction In order to accommodate the growing list of patients awaiting liver transplantation, the transplant community has increased efforts to expand the donor pool by utilization of extended criteria donor organs [1, 2], which include organs distinguished by hepatic steatosis, old donor age, prolonged cold ischemia, or donation after cardiac death. These grafts are susceptible to preservation injury and as a consequence are prone to a higher incidence of early allograft dysfunction (EAD) [3]. Moreover, severe ischemia/reperfusion injury (IRI) significantly impacts transplantation outcome because it is a major risk factor for both early graft failure and late chronic allograft dysfunction. Pharmacological preconditioning is one of the tools used to diminish preservation injury. Although volatile anesthetics and propofol have been studied to attenuate injury in liver resections with inflow occlusion [4, 5], pharmacological preconditioning with sevoflurane of human liver grafts from deceased brain donors has not yet been described. The purpose of this study was to evaluate the influence of sevoflurane preconditioning of liver grafts from deceased brain donors on postoperative graft function in patients undergoing liver transplantation. 2. Materials and Methods Deceased
%U http://www.hindawi.com/journals/arp/2012/930487/