Effect of Desflurane on Pediatric Acute Respiratory Distress Syndrome After Living Donor Liver Transplant Recipients

Study Overview
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Brief Summary
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Biliary atresia is a serious congenital anomaly characterized by persistent and progressive cholestatic jaundice. The incidence of biliary atresia is more common in East Asia, especially China, with an incidence of 2 per 10,000 live births. Liver transplantation is the only effective way to treat end-stage liver disease. However, distant organ damage, affecting the heart, brain, kidneys, lungs, and intestines, is still an important factor affecting the long-term survival of children after surgery. Desflurane is a volatile anesthetic commonly used in surgery. In order to observe the effect of desflurane on the incidence of early postoperative pediatric acute respiratory distress syndrome (PARDS) with biliary atresia who underwent living donor liver transplantation, and explore the related mechanism, a total of 165 infant patients underwent living liver transplantation due to biliary atresia from March 2023 to October 2023 are included in our single-center prospective study. They are randomly divided into propofol group (n=55), propofol and desflurane group (n=55) and desflurane group (n=55) according to the difference of intraoperative anesthesia maintenance. Gender, age, height, weight, PELD scores and other preoperative basic data are recorded. Operation time, anhepatic time and intraoperative blood loss volume are recorded. The basic information of liver donors are also recorded. Postoperative mechanical ventilation time, ICU stay time, tacrolimus concentration, total length of hospital stay and mortality during hospitalization are recorded. According to the the definition of PARDS recommended by the 2015 Pediatric Acute Lung Injury Consensus Conference is used as the diagnostic and grading criteria for postoperative PARDS, and the incidence and grading of PARDS within the first seven days after surgery are evaluated in the three groups. Peripheral blood is collected immediately after anesthesia induction, 30min after reperfusion and at the end of surgery to detect serum levels of HMGB1, IL-6 and TNF-α by enzyme linked immunosorbent assay (ELISA).

Official Title
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Effect of Desflurane on Pediatric Acute Respiratory Distress Syndrome After Living Donor Liver Transplant Recipients

Conditions
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Pediatric Acute Respiratory Distress Syndrome, Desflurane, Biliary Atresia

Intervention / Treatment
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* Drug: desflurane
* Drug: propofol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The diagnosis was biliary atresia Living donors were either the father or the mother 3months ≤age ≤ 36 months Exclusion Criteria: The preoperative diagnosis was not biliary atresia The donor was not a parent Age <3months or>36 months The patient had perinatal disease or congenital cardiopulmonary deformity The patient had acute respiratory infection before surgery The patient had hepatopulmonary syndrome Retransplantation

Ages Eligible for Study
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Minimum Age: 3 Months
Maximum Age: 36 Months

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: propofol group<br> | Drug: propofol<br>* Intraoperative anesthesia maintenance<br>|
| Experimental: propofol and desflurane group<br> | Drug: desflurane<br>* Intraoperative anesthesia maintenance<br>Drug: propofol<br>* Intraoperative anesthesia maintenance<br>|
| Experimental: desflurane group<br> | Drug: desflurane<br>* Intraoperative anesthesia maintenance<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the incidence of PARDS | the definition of PARDS recommended by the 2015 Pediatric Acute Lung Injury Consensus Conference | 7 days after LDLT | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| High mobility group box 1 | Peripheral blood is collected | immediately after anesthesia induction, 30minutes after reperfusion and at the end of surgery（up to 30minutes） | 
| Interleukin-6 | Peripheral blood is collected | immediately after anesthesia induction, 30minutes after reperfusion and at the end of surgery（up to 30minutes） | 
| Tumor necrosis factor-alpha | Peripheral blood is collected | immediately after anesthesia induction, 30minutes after reperfusion and at the end of surgery（up to 30minutes） | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Living Donor Liver Transplant, Pediatric Acute Respiratory Distress Syndrome, Desflurane, Biliary atresia