Abstract: Objective The aim of this study was to investigate the impact of combined sevoflurane anesthesia on renal functions in pediatric living donor liver transplantation (LDLT). Methods 54 children with end stage liver diseases (including congenital biliary atresia in 31 cases, hepatolenticular degeneration in 10 cases, hepatic glycogen storage disease in 8 cases and liver failure in 5 cases ) were recruited in our hospital between March 2017 and March 2020, and all received LDLT. The anesthesia included combined sevoflurane in 20 cases (groupA), combined isoflurane in 18 cases (group B) and combined propofol anesthesia in 16 cases (group C). Serum lactate dehydrogenase (LDH), serum creatinine (sCr), and urea nitrogen (BUN) and renal artery resistance index (RI)determined by ultrasonography were obtained. A 1 day before operation (T₁), 1 day after operation (T₂), 3 days after operation (T₃) and 5 days afteroperation (T₄), the mean arterial pressure (MAP), central venous pressure (CVP) and heart rate (HR) were recorded. Results At T₂, T₃ and T₄, serum LDH level in group A were (502.7±114.4)IU/L, (392.8±128.4)IU/L and (340.6±94.3)IU/L, all significantly lower than [(582.0±104.8)IU/L, (511.7±94.5)IU/L and (450.6±80.6)IU/L, respectively, P<0.05] in group B or [(579.6±106.7)IU/L, (498.9±95.2)IU/L and (443.6±82.1)IU/L, respectively, P<0.05] in group C; sCr were (60.8±13.2)μmol/L,(45.4±9.7)μmol/L and (33.2±8.5)μmol/L, all significantly lower than [(71.6±12.8)μmol/L, (58.4±10.3)μmol/L and (49.5±8.9)μmol/L, respectively, P<0.05] in group B or [(69.3±10.0)μmol/L,(62.2±9.7)μmol/L and (50.3±8.6)μmol/L, respectively, P<0.05] in group C; the MAP were (49.3±3.7)mm/Hg, 52.9±4.9)mm/Hg and (55.3±4.6)mm/Hg, all significantly higher than [(45.9±4.3)mm/Hg, (47.7±3.9)mm/Hg and (51.9±4.5)mmHg, respectively, P<0.05] in group B or [(44.9±4.4)mm/Hg,(49.2±4.6)mmHg and (51.8±5.0)mm/Hg, respectively, P<0.05] in group C, the CVP were (6.9±1.4)mm/Hg,(7.8±2.0)mm/Hg and (8.4±1.5)mm/Hg,all significantly higher than [(5.8±1.5)mm/Hg, (6.4±1.7)mm/Hg and (7.4±1.3)mm/Hg, respectively,P<0.05] in group B or [(5.6±1.3)mm/Hg, (6.5±1.2)mm/Hg and 7.4±0.9)mm/Hg, respectively, P<0.05] in group C. Conclusion The combined sevoflurane anesthesia could protect renal functions in children receiving LDLT, which might be related to the less impact on hemodynamics.

Key words: Living donor liver transplantation, Anesthesia, Sevoflurane, Renal functions, Hemodynamics, Children