Propofol total intravenous anesthesia versus sevoflurane anesthesia on graft function following donation-after-cardiac-death kidney transplantation: A retrospective cohort study

Background Delayed graft function (DGF) is a common complication following donation-after-cardiac-death (DCD) kidney transplantation. Propofol and sevoflurane both exhibit renoprotective properties in preclinical studies; however, comparative clinical evidence on this high-risk population is limited. Methods This single-center retrospective cohort study examined 638 adult patients who underwent DCD kidney transplantation under general anesthesia with either propofol total intravenous anesthesia (TIVA) (n = 240) or sevoflurane anesthesia (n = 398). Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates. Incidence of DGF, defined as dialysis requirement within the first postoperative week, made up the primary outcome. Results DGF occurred in 65 of 240 patients (27.1%) in the propofol group and 142 of 398 patients (35.7%) in the sevoflurane group (unadjusted odds ratio [OR] = 0.67; 95% confidence interval [CI], 0.47–0.95; P = 0.025). This difference persisted after IPTW adjustment (OR = 0.73; 95% CI, 0.51–0.98; P = 0.041). The proportion of patients requiring dialysis within 30 days following the operation was also significantly lower in the propofol group (IPTW-adjusted OR = 0.67; 95% CI, 0.47–0.94; P = 0.023). Serum creatinine and blood urea nitrogen levels were found to be significantly lower in the propofol group at seven days after the operation, with no significant differences observed at later time points. No differences in terms of 30-day acute rejection, graft vascular complications, length of hospital stay, or one-year graft survival between the groups were detected. The associations remained consistent in sensitivity analyses that also accounted for intraoperative variables. Conclusions Propofol TIVA used in DCD kidney transplantation may be associated with a lower incidence of DGF and improved early graft function compared to sevoflurane anesthesia. Prospective randomized controlled trials are warranted to verify these observations.