Comparison of the effect of Desflurane versus total intravenous anesthesia with Propofol on ischemia reperfusion injury and liver regeneration in liver transplant recipients - A randomised controlled trial
试验速览
- 阶段
- 4 期
- 状态
- 招募中
- 入组人数
- 72
- 试验地点
- 1
- 主要终点
- Desflurane is comparable to TIVA with Propofol in preventing hepatocyte ischemia-reperfusion injury and promoting hepatic regeneration.
研究概览
简要总结
Orthotopic liver transplantation is the definitive treatment for end-stage liver disease. Donor hepatectomy is performed on healthy individuals with minimal comorbidities. The type of anesthesia used, along with cold and warm ischemia times and dissection duration, significantly impacts liver regeneration and postoperative function.
Hepatocytes typically proliferate in response to stimuli like toxic injury or surgery. After hepatectomy, the remaining liver enlarges to restore normal mass and function, usually within 10 days. This process begins with an acute phase response, activating cytokines such as TNF-α and IL-6, which prompt hepatocytes to enter the cell cycle. Growth factors like HGF and VEGF then facilitate the progression of liver regeneration.
Hepatic ischemia-reperfusion injury (IRI) involves inflammation, free radical production, and mitochondrial damage. Protective strategies against IRI include both surgical and pharmacologic interventions aimed at minimizing cellular injury during reperfusion.
Desflurane, a fluorine-containing volatile anesthetic, is commonly used in liver transplantation due to its minimal impact on liver function and real-time concentration monitoring. It offers hepatoprotection by inhibiting NF-κB activation and reducing inflammatory factors, leading to lower post-transplant serum ALT and TB levels.
Propofol, an intravenous anesthetic with antioxidant properties, has also shown potential in reducing oxidative stress and IRI. It may contribute to liver regeneration by reducing apoptosis and promoting cell proliferation.
This study aims to compare the effects of desflurane and propofol on ischemia-reperfusion injury and liver regeneration during orthotopic liver transplantation, from donor dissection through recipient transplantation.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 盲法
- None
入排标准
- 年龄范围
- 18.00 Year(s) 至 65.00 Year(s)（—）
- 性别
- All
入选标准
- •Patients undergoing elective living donor liver transplantation for chronic liver disease Agrees to participate in research Age 18-65 years.
排除标准
- •Refusal to consent Acute liver failure, Acute on chronic liver failure Allergic to propofol or any component of propofol Patients with pre existing cardiac dysfunction and cardiomyopathy Patients with pre existing renal dysfunction/ deranged RFTs preoperatively.
结局指标
主要结局
Desflurane is comparable to TIVA with Propofol in preventing hepatocyte ischemia-reperfusion injury and promoting hepatic regeneration.
时间窗: 14 days
次要结局
- To compare the serum levels of liver regeneration markers [hepatocyte growth factor(HGF), Vascular enndothelial growth factor(VEGF)] during baseline, POD 1 and 7(Comparison of the incidence of ischemia reperfusion injury using the serum levels of markers CK 8/18, VWF, IL-6, IL-1β, TNF-α, HMGB-1, mtDNA, LDH, lactic acid during baseline, immediate post-reperfusion(30min-1hr), early post-reperfusion(6h-12h), early postoperative period(24h-48h).)
研究者
Kondaveeti Anusha
Institute of liver and biliary sciences