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P-1.02 Intraoperative low-dose dexmedetomidine attenuates hepatic ischemia-reperfusion injury in pediatric living donor liver transplantation

Liang Zhang, People's Republic of China

Associate Chief Anesthesiologist
Anesthesiology
Beijing Friendship Hospital, Capital Medical University

Abstract

Intraoperative low-dose dexmedetomidine attenuates hepatic ischemia-reperfusion injury in pediatric living donor liver transplantation

Liang Zhang1, Wenhe Yang1, Fushan Xue1, Azmat Riaz2, Zhijun Zhu3,4,5.

1Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China; 2Anesthesiology, Pak-Emirates Military Hospital, Rawalpindi, Pakistan; 3Liver Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China; 4Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, People's Republic of China; 5Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing, People's Republic of China

Background: Dexmedetomidine (DEX) is an anesthetic adjuvant increasingly used in pediatric anesthesia. However, the impact of low-dose DEX on postoperative liver graft function in pediatric living donor liver transplantation (LDLT) is still unclear. The objective of this retrospective study was to explore its potential hepatoprotective effect in pediatric LDLT.
Methods: A retrospective study of 115 pediatric patients submitted to LDLT from January 2016 to December 2018 was conducted. Patients were stratified into DEX and non-DEX groups according to intraoperative DEX use and different time periods in our hospital. Patients in the DEX group (n = 62) received an additional infusion of DEX at the rate of 0.4 μg/kg/h compared with those in the Non-DEX group (n = 53). Data on postoperative liver graft function and other variables were collected and compared. Propensity score (PS) matching analysis was designed to control selection bias. Independent predictors of moderate-to-extreme hepatic ischemia-reperfusion injury (HIRI) were identified by binary logistic regression.
Results: The DEX group showed lower postoperative peak alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase, and blood urea nitrogen levels (All P<0.05), less frequent development of moderate-to-extreme HIRI (P = .013), and shorter duration of hospital stay (P = .011) than the non-DEX group.

Even after PS matching, intraoperative DEX infusion was associated with decreased postoperative lactic dehydrogenase level and hospitalization (P = .047 and P = .020, respectively).

Moreover, multivariate analysis revealed that larger graft-to-recipient weight ratio (odds ratio [OR] = 1.067 [95% confidence interval {CI}, 1.012–1.125]; P = .017) and intraoperative DEX administration (OR = 0.325 [95% CI, 0.125–0.843]; P = .021) were independent predictors of moderate-to-extreme HIRI.

Conclusion: Intraoperative low-dose DEX infusion had a potentially protective effect liver graft function in pediatric LDLT without noticeably side effects.

References:

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