Total intravenous anesthesia in kidney transplantation: A narrative review

Table 1 Risk-of-bias appraisal of included human comparative studies

Ref.	Design	Tool	Highest-risk domain(s)	Overall judgement	Comments
Aditianingsih et al[9], 2019	RCT (KT)	RoB 2	Blinding of personnel	Some concerns	Adequate randomisation; small sample size
Nieuwenhuijs-Moeke et al[10], 2017	RCT (KT)	RoB 2	Selection of reported result	Low-some concerns	Calculation-error corrigendum acknowledged
Modesti et al[2], 2006	RCT (KT)	RoB 2	Era effect; concomitant interventions	Some concerns	Dopamine infusions; HES colloids - now superseded
Babacan et al[12], 1998	RCT (KT)	RoB 2	Reporting; randomisation detail	High	Small sample size; limited methodological detail
Lee et al[3], 2013 (part-I)	Retrospective (KT)	ROBINS-I	Confounding	Serious	Non-randomised treatment allocation
Lee et al[3], 2013 (part-II)	Prospective (KT)	ROBINS-I	Confounding	Moderate	Did not confirm part-I signal
Calixto-Flores et al[13], 2020	Retrospective (KT)	ROBINS-I	Confounding; single-arm	Serious	No comparator group
Han et al[11], 2020	RCT (donors)	RoB 2	Indirectness (donors, not recipients)	Low (for donor outcomes)	Informs recovery outcomes only
Franzén et al[8], 2022	RCT (surgical patients)	RoB 2	Indirectness (surgical pts, not KT)	Low (for renal function in surgical pts)	Contemporary mechanistic evidence; indirect for KT
Liu et al[1], 2024	RCT (paediatric LRLT)	RoB 2	Indirectness (paediatric, liver, not adult KT)	Low (for liver/kidney outcomes in infants)	Mechanistic reference only; not directly extrapolable

The preclinical ovine model (Iguchi et al[7] 2019) is not amenable to Risk of Bias 2 or ROBINS-I appraisal and is omitted. HES: Hydroxyethyl starch; RCT: Randomised controlled trial; KT: Kidney transplant; RoB 2: Risk of Bias 2; LRLT: Living-related liver transplantation.