Total intravenous anesthesia in kidney transplantation: a narrative review
File(s)
Published version
Author(s)
Rangganata, Ervandy
Castellanos De Brigard, Juanita
Prionas, Apostolos
Habib, Nagy
Papalois, Vassilios E
Type
Journal Article
Abstract
BACKGROUND
Kidney transplantation is the treatment of choice for end-stage renal disease. Whether propofol-based total intravenous anaesthesia (TIVA) confers advantages over volatile anaesthesia for perioperative stability, recovery, and graft outcomes remains debated.
AIM
To synthesise the currently available comparative evidence on propofol-based TIVA versus volatile anaesthesia in adult kidney transplantation—focusing on haemodynamic stability, renal injury biomarkers, early graft function, recovery, postoperative nausea and vomiting (PONV), immunologic outcomes, and safety—and to identify the key evidence gaps and priorities for future research.
METHODS
We performed a narrative review following the Scale for the Assessment of Narrative Review Articles framework, with structured search and selection consistent with PRISMA-S reporting. PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Scopus, and Web of Science were searched from inception to February 2026. Quality was appraised using Cochrane Risk of Bias 2 and ROBINS-I. Six studies were directly eligible in adult kidney transplant recipients; four supplementary mechanistic sources informed interpretation.
RESULTS
TIVA provided haemodynamic stability and immediate graft function equivalent to volatile anaesthesia. Urinary tubular biomarkers (kidney injury molecule-1, N-acetyl-β-D-glucosaminidase) were modestly lower with propofol in the VAPOR-1 trial (n = 57 living-donor pairs), but this did not translate into differences in delayed graft function, serum creatinine, or one-year graft survival. TIVA was associated with faster extubation and lower PONV, though recovery comparisons were confounded by opioid co-administration. Acute rejection rates did not differ significantly.
CONCLUSION
Propofol-based TIVA is a safe and effective alternative to volatile anaesthesia in kidney transplantation. Whether the cellular-level biomarker signal translates into clinically meaningful renoprotection in higher-risk grafts requires adequately powered multicentre trials with standardised perioperative protocols.
Kidney transplantation is the treatment of choice for end-stage renal disease. Whether propofol-based total intravenous anaesthesia (TIVA) confers advantages over volatile anaesthesia for perioperative stability, recovery, and graft outcomes remains debated.
AIM
To synthesise the currently available comparative evidence on propofol-based TIVA versus volatile anaesthesia in adult kidney transplantation—focusing on haemodynamic stability, renal injury biomarkers, early graft function, recovery, postoperative nausea and vomiting (PONV), immunologic outcomes, and safety—and to identify the key evidence gaps and priorities for future research.
METHODS
We performed a narrative review following the Scale for the Assessment of Narrative Review Articles framework, with structured search and selection consistent with PRISMA-S reporting. PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Scopus, and Web of Science were searched from inception to February 2026. Quality was appraised using Cochrane Risk of Bias 2 and ROBINS-I. Six studies were directly eligible in adult kidney transplant recipients; four supplementary mechanistic sources informed interpretation.
RESULTS
TIVA provided haemodynamic stability and immediate graft function equivalent to volatile anaesthesia. Urinary tubular biomarkers (kidney injury molecule-1, N-acetyl-β-D-glucosaminidase) were modestly lower with propofol in the VAPOR-1 trial (n = 57 living-donor pairs), but this did not translate into differences in delayed graft function, serum creatinine, or one-year graft survival. TIVA was associated with faster extubation and lower PONV, though recovery comparisons were confounded by opioid co-administration. Acute rejection rates did not differ significantly.
CONCLUSION
Propofol-based TIVA is a safe and effective alternative to volatile anaesthesia in kidney transplantation. Whether the cellular-level biomarker signal translates into clinically meaningful renoprotection in higher-risk grafts requires adequately powered multicentre trials with standardised perioperative protocols.
Date Issued
2026-09-18
Date Acceptance
2026-07-27
Citation
World Journal of Transplantation, 2026, 16 (3)
ISSN
2220-3230
Publisher
Baishideng Publishing Group Inc.
Journal / Book Title
World Journal of Transplantation
Volume
16
Issue
3
Copyright Statement
©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc. Rangganata E, Castellanos De Brigard J, Prionas A, Habib N, Papalois VE. Total intravenous anesthesia in kidney transplantation: A narrative review. World J Transplant 2026; 16(3): 121739 [DOI: 10.5500/wjt.121739]
License URL
Publication Status
Published
Article Number
121739
Date Publish Online
2026-09-18