Impact of sevoflurane versus isoflurane on coagulation profile in living donor liver transplant recipients: a prospective randomized trial

Background End-stage liver disease is characterized by severe coagulopathy, and bleeding is common during liver transplantation (Ltx). Previous studies reported a depressant effect of some inhalational anesthetics on platelet function in normal patients. None of them investigated this effect in Ltx recipients with end-stage liver disease. In this study, we evaluated the effects of sevoflurane versus isoflurane on coagulation function, blood loss, and transfusion requirements in living donor liver transplantation recipients. Patients and methods A total of 32 patients of either sex, with MELD score between 12 and 18 scheduled for living donor liver transplantation, were randomly allocated into either the sevoflurane group ( N = 18) or the isoflurane group ( N = 14), based on the inhalational anesthetics used. Standard hemodynamic monitoring was applied. All operations were performed by the same anesthesia and surgery teams. All patients were administered propofol/fentanyl and rocuronium bromide for induction, followed by continuous infusion of fentanyl for analgesia and rocuronium bromide for muscle relaxation. Samples for INR, prothrombin time, bleeding time, Factor V, Factor VII, serum fibrinogen, complete blood picture, and aPTT were collected before the induction of anesthesia, end hepatectomy, 60 min after reperfusion, and 6, 12, 24 h in the ICU. Amounts of blood loss and blood components transfusion were also recorded at the end of operation and first postoperative day. Results Both the groups had comparable demographics, coagulation profiles, and MELD scores. Bleeding time was significantly longer in the sevoflurane group ( P = 0.04), starting at end hepatectomy and persisted till the sixth hour postoperative reading, compared with the isoflurane group. INR, aPTT, PT, Factor V and Factor VII, and Hg were comparable in both groups. Platelet count was also not significantly different between both groups. Blood loss and transfusion requirements were comparable in both groups. No outcome difference was observed between groups. Conclusion In Ltx recipients, sevoflurane induced prolongation of the bleeding time compared with the isoflurane group. Yet, no clinically significant impact was encountered regarding blood loss and transfusion requirements either during intraoperative or the early postoperative period.