A Comparison of Propofol Based Total Intravenous Anesthesia and Desflurane Based Balanced Anesthesia on Renal Protection During Deceased Brain Dead Donor Kidney Transplantation - A Prospective, Randomized Trial

Study Overview
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Brief Summary
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Renal ischemia/reperfusion (I/R)-induced injury is known to be associated with immediate and long-term kidney dysfunction after renal transplantation. Protecting the kidney against I/R injury and maintaining renal function during renal transplant surgery is therefore very important in order to improve post-operative outcome. This purpose of this study is to investigate whether propofol anesthesia done in both kidney donors and recipients during deceased brain dead donor kidney transplantation is effective in reducing renal I/R injury via its antioxidant and antiinflammatory properties and improve post-transplant outcome compared to desflurane anesthesia.

Conditions
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End Stage Renal Disease

Intervention / Treatment
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* Drug: Desflurane balanced anesthesia
* Drug: Propofol total intravenous anesthesia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult deceased brain dead kidney donors and recipients scheduled for renal transplantation Exclusion Criteria: 1. Donor exclusion criteria: (1) Refusal of legal guardian 2. Recipient exclusion criteria: Patient refusal Hypersensitivity to propofol, soybeans or peanuts History of vitamin C or E intake within 5 days before surgery History of acute myocardial infarct within 6 months before surgery Congestive heart failure (NYHA III-IV) Autoimmune disease patients BMI over 30 kg/m2 Left ventricular ejection fraction less than 35% upon preoperative echocardiography

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 69 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Desflurane balanced anesthesia group<br> | Drug: Desflurane balanced anesthesia<br>* Desflurane balanced anesthesia induced with thiopental sodium, remifentanil and atracurium and maintained with remifentanil target controlled infusion and desflurane inhalation<br>|
| Active Comparator: Propofol total intravenous anesthesia group<br> | Drug: Propofol total intravenous anesthesia<br>* Propofol total intravenous anesthesia induced with propofol, remifentanil and atracurium and maintained with remifentanil and propofol target controlled infusion<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The difference in inflammatory markers of recipients between groups during and after renal transplantation (CRP, WBC differential count, IL-6, TGF-β) | Kidney donor: Inflammatory markers are evaluated immediately after anesthesia induction, right before kidney extraction and 1 hour after kidney extraction Kidney recipient: (1) Inflammatory markers: Immediately after anesthesia induction, 2 and 24 hours after reperfusion (2) Renal function markers: Before anesthesia, 2 hours after reperfusion, immediate post-op, 24 and 48 hours postoperatively | Inflammatory markers are evelauted immediately after anesthesia induction, right before kidney extraction and 1 hour after kidney extraction | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The difference in renal function of kidney recipients between groups after renal transplantation (BUN/Cr, cystatin C, NGAL) | Kidney donor: Inflammatory markers are evaluated immediately after anesthesia induction, right before kidney extraction and 1 hour after kidney extraction Kidney recipient: (1) Inflammatory markers: Immediately after anesthesia induction, 2 and 24 hours after reperfusion (2) Renal function markers: Before anesthesia, 2 hours after reperfusion, immediate post-op, 24 and 48 hours postoperatively | immediately after anesthesia induction, right before kidney extraction and 1 hour after kidney extraction | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Propofol, renal protection, kidney transplantation