Propofol-based anaesthesia versus sevoflurane-based anaesthesia for living donor kidney transplantation:results of the VAPOR-1 randomized controlled trial

Background. Kidney transplantation is associated with harmful processes affecting the viability of the graft. One of these processes is associated with the phenomenon of ischaemia-reperfusion injury. Anaesthetic conditioning is a widely described strategy to attenuate ischaemia-reperfusion injury. We therefore conducted the Volatile Anaesthetic Protection of Renal Transplants-1 trial, a pilot project evaluating the influence of two anaesthetic regimens, propofol-vs sevoflurane-based anaesthesia, on biochemical and clinical outcomes in living donor kidney transplantation.Methods. Sixty couples were randomly assigned to the following three groups: PROP (donor and recipient propofol), SEVO (donor and recipient sevoflurane), and PROSE (donor propofol and recipient sevoflurane). The primary outcome was renal injury reflected by urinary biomarkers. The follow-up period was 2 yr.Results. Three couples were excluded, leaving 57 couples for analysis. Concentrations of kidney injury molecule-1 (KIM-1), N-acetyl-beta-D-glucosaminidase (NAG), and heart-type fatty acid binding protein (H-FABP) in the first urine upon reperfusion showed no differences. On day 2, KIM-1 concentrations were higher in SEVO [952.8 (interquartile range 311.8-1893.0) pg mmol(-1)] compared with PROP [301.2 (202.0-504.7) pg mmol(-1)]. This was the same for NAG: SEVO, 1.835 (1.162-2.457) IU mmol(-1) vs PROP, 1.078 (0.819-1.713) IU mmol(-1). Concentrations of H-FABP showed no differences. Measured glomerular filtration rate at 3, 6, and 12 months showed no difference. After 2 yr, there was a difference in the acute rejection rate (P = 0.039). Post hoc testing revealed a difference between PROP (35%) and PROSE (5%; P = 0.020). The difference between PROP and SEVO (11%) was not significant (P = 0.110).Conclusions. The SEVO group showed higher urinary KIM-1 and NAG concentrations in living donor kidney transplantation on the second day after transplantation. This was not reflected in inferior graft outcome.