Total intravenous anesthesia in kidney transplantation: A narrative review

Table 2 Summary of all ten studies included in this review (six directly eligible kidney-transplant studies plus four mechanistically instructive supplementary studies)

Study	Title	Design	Population	Intervention	Key outcomes
Aditianingsih et al[9], 2019	TCI PROP vs SEVO haemodynamics in KT	Prospective RCT	46 adult KT recipients	TCI PROP vs SEVO	Similar MAP, CI, SVI; lower SVRI with PROP
Nieuwenhuijs-Moeke et al[10], 2017	PROP vs SEVO in LDKT	RCT	57 donor-recipient pairs	PROP, SEVO, PROSE	Higher urinary KIM-1, NAG with SEVO; non-significant numerical trend to higher acute rejection in PROP arm (did not reach statistical significance)
Modesti et al[2], 2006	Balanced vs TIVA for KT—older-era regimen	RCT	40 adult KT recipients	TIVA (PROP + remifentanil) vs balanced (isoflurane + fentanyl)	TIVA: Faster recovery; balanced: Marginally better early pain control (likely opioid-driven)
Babacan et al[12], 1998	Assessment of TIVA in renal transplantation—older-era regimen	RCT	18 adult KT recipients	TIVA (PROP + alfentanil) vs balanced (isoflurane + fentanyl)	Faster recovery with TIVA; better early analgesia with balanced (likely opioid-driven)
Lee et al[3], 2013	Preconditioning effects of donor anaesthetic on grafted kidney function	Retrospective + prospective	LDKT recipients (adult)	SEVO, iso, desflurane vs PROP	Desflurane: Better early estimated glomerular filtration rate (part I); no significant difference in part II
Calixto-Flores et al[13], 2020	Effect of intravenous total anaesthesia on haemodynamic changes in renal transplant	Retrospective observational (single-arm)	30 adult KT recipients	TIVA (single arm)	Stable haemodynamics; spontaneous diuresis in approximately 90%
Han et al[11], 2020	PROP vs SEVO in laparoscopic donor nephrectomy	RCT	80 healthy kidney donors	PROP vs SEVO	Higher QoR-40, better ambulation, lower PONV, shorter LOS with PROP
Franzén et al[8], 2022	Renal function during SEVO or TIVA PROP—single-centre RCT	RCT	Surgical patients (not transplant)	SEVO vs PROP-based TIVA	Contemporary mechanistic evidence on renal function under SEVO vs PROP
Liu et al[1], 2024	PROP vs desflurane in infant LRLT	RCT	76 infants with LRLT	PROP vs desflurane	Lower ALT, AST, SCr, AKI in PROP group; mechanistic relevance only
Iguchi et al[7], 2019	Renal perfusion, oxygenation, and sympathetic nerve activity during volatile or intravenous general anaesthesia in sheep	Preclinical (ovine)	Sheep	PROP-based TIVA vs volatile anaesthesia	Higher RBF and renal vascular conductance under TIVA; reduced sympathetic vasomotor drive; mechanistic background only

TIVA: Total intravenous anaesthesia; TCI: Target-controlled infusion; KT: Kidney transplant; RCT: Randomised controlled trial; MAP: Mean arterial pressure; CI: Cardiac index; SVI: Stroke volume index; SVRI: Systemic vascular resistance index; LDKT: Living-donor kidney transplant; PROP: Propofol; SEVO: Sevoflurane; PROSE: Propofol induction and sevoflurane maintenance; KIM-1: Kidney injury molecule-1; NAG: N-acetyl-β-D-glucosaminidase; PONV: Postoperative nausea and vomiting; LOS: Length of stay; LRLT: Living-related liver transplantation; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; SCr: Serum creatinine; AKI: Acute kidney injury; RBF: Renal blood flow.