Influence of anesthesia on microcirculation in renal transplant at the stages of kidney transplantation from a living related donor

Background. Living-related donor kidney transplantation (LRDKT) is an effective renal replacement therapy for patients with end-stage chronic kidney disease. The role of anesthesia during laparoscopic donor nephrectomy (LDN) for ischemia-reperfusion injury (IRI) of the renal graft (RG) remains unclear. Objective. To evaluate the effect of combined intravenous—inhalation anesthesia (CIVIA) and combined epidural and general anesthesia (GEA) on RG perfusion during LDN and its baseline function. Material and methods. This open-label prospective single-center study included 35 donor-recipient pairs. Random assignment was performed. Group 1 included donors who underwent CIVIA (n=20), group 2 — LDN under GEA (n=15). Group 3 included recipients who underwent RG transplantation from group 1 under CIVIA (n=20), group 4 (n=15) — RG transplantation from group 2 under CIVIA. RG microcirculation was assessed intraoperatively using laser Doppler flowmetry at 3 stages: kidney harvesting, epidural administration of lidocaine hydrochloride, and reperfusion. Baseline RG function (glomerular filtration rate, blood creatinine and urea, daily diuresis) was analyzed on days 1 and 7. Statistical analysis was performed in SPSS 17.0 (SPSS: An IBM Company, USA). Data distribution differed from normal (Shapiro-Wilk test), and we used nonparametric methods. The Mann-Whitney U test was used for pairwise comparisons of independent groups, while the Wilcoxon (2 points) and Friedman (3 or more points) tests were used for comparisons of dependent samples. Data are presented as medians and quartiles: Me (Q1; Q3). Statistical significance with Bonferroni correction was set at p<0.00625. Results. At the reperfusion stage, microcirculation index in group 4 was 31.5 perfusion units versus 20.6 units in group 3 (p=0.00002). On the first day, GFR in group 4 was higher by 17.7%, while creatinine and urea were lower by 12.5% and 13%, respectively (p<0.005). By the 7th day, GFR in group 4 was 52.7 versus 38.5 ml/min/1.73 m² in group 3 (p<0.00001). Conclusion. GEA affects microcirculation, reduces the risk of IRI and accelerates RG recovery after LRDKT.