The Effect of Inhaled Anesthetic Administration on Deceased Organ Donors and Transplant Recipients

IntroductionDue to the organ shortage, effective treatments for early graft dysfunction are critically needed. Early graft dysfunction is associated with a prolonged hospital stay, acute rejection, and mortality. Ischemia-reperfusion injury is a major contributor to early graft dysfunction. Inhaled anesthetics may reduce ischemia-reperfusion injury and improve donation and transplant outcomes.ObjectiveThis review aimed to summarize clinical studies of inhaled anesthetics administration to deceased donors, investigating downstream effects on transplant outcomes.MethodsWe searched MEDLINE, EMBASE, Cochrane Library, and conference proceedings for clinical studies comparing deceased donors' treatment with inhaled anesthetics to either placebo or no intervention and evaluating outcomes for any organ transplantation. Reviewers independently screened and selected studies, extracted data, and assessed the risk of bias. We assessed the overall quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.ResultsThree studies with different inhaled anesthetics regimens were included. Most studies have assessed the effects of sevoflurane. Conflicting results were reported on early graft dysfunction since 1 study showed a reduced incidence, while the other 2 did not report any difference. Two studies evaluated graft function, with peak serum alanine transaminase and aspartate aminotransferase improvements in the intervention groups. No difference in graft survival was reported between the 2 studies. The quality of evidence was very low for all outcomes.DiscussionCurrent studies offer limited evidence to support the use of inhaled anesthetics preconditioning in deceased donors. Since there is physiological plausibility of their use, rigorous randomized clinical trials are needed to establish clear conclusions on their benefits.