Table 2.

Clinical trials.

Author	Year	Type of Study	Population	Main Results	Comments
Liver Resection
Beck-Schimmer et al. [59]	2008	RCT	Liver resection with inflow occlusion (>30 min); 64 patients (anesthetized with propofol): -34 control group -30 sevo preC (30 min up to 3.2%)	Peak transaminases, complication rate, major complications: significantly reduced Hospital, ICU LOS: no statistical difference	Patients with cirrhosis excluded Stronger protective effects in patients with steatosis iNOS significantly upregulated in the preC group
Song et al. [61]	2010	RCT	Liver resection with inflow occlusion 100 patients: -50 propofol group -50 sevo conditioning group	Peak transaminases, bilirubin, ALP, hospital LOS: no significant difference	Non-significant increase in peak transaminases in cirrhotic patients
Slankamenac et al. [62]	2012	retrospective	Liver resection with inflow occlusion 227 patients: -86 propofol group -141 sevo conditioning	Peak transaminases, hospital LOS, ICU LOS, complication rates: no significant difference	Possible negative selection bias: sevoflurane preferentially used in patients with more severe comorbidities
Beck-Schimmer et al. [58]	2012	RCT	Liver resection 115 patients (anesthetized with propofol): -17 inflow occlusion (>30 min) (control) -50 IC -48 inflow occlusion (>30 min) + sevo postC (30 min up to 3.2%)	Peak AST, complication rates, hospital LOS: significantly reduced with postC and IC compared to control No significant difference between IC and sevo postC	Patients with cirrhosis excluded
Rodriguez et al. [64]	2015	RCT	Liver resection with IC 107 patients (anesthetized with propofol): -36 IPC (10 min) -34 Sevo preC (20 min at 1.5 MAC) -36 IC alone (control)	Postoperative transaminases, bilirubin, INR, histological analysis, complication rates, hospital LOS: no significant difference between the groups	Patients with cirrhosis excluded iNOS 1h after reperfusion similar to baseline in all groups
Simillis et al. [63]	2016	Network meta-analysis	Liver resection with inflow occlusion	Serious adverse events: significantly reduced. Hospital LOS: no significant difference	Includes only two RCTs [58,59]
Eichler et al. [60]	2017	Cost analysis of two RCTs	Liver resection with inflow occlusion 129 patients (anesthetized with propofol): -78 sevo preC or postC -51 propofol alone (control)	Nonsignificant reduction of costs with sevo preC or postC compared to control	Based on two RCTs [58,59] Cost reduction due to significant reduction of complication rates in the preC or postC group
Liver transplantation
Minou et al. [65]	2012	RCT	LT; DBD 60 donors: -30 sevo 2% preC -30 No VA (control)	Peak transaminases, incidence of EAD: significantly reduced in sevo group	No significant difference in peak transaminases or EAD in subgroup without steatosis Maintenance of anesthesia in the recipient with sevo in both groups
Beck-Schimmer et al. [69]	2015	RCT	LT 98 recipients: -50 sevo postC (entire procedure) -48 propofol (control)	Peak transaminases, incidence of EAD, complication rates, ICU LOS, hospital LOS: no significant difference	Nonsignificant difference in severity of complications in favor of sevo postC group
Lee et al. [68]	2016	RCT	Adult LDLT 62 recipients: -31 sevo postC (entire procedure) -31 desflurane (control)	Incidence of PRS: significantly reduced in sevo group Postoperative transaminases, bilirubin, hospital and ICU LOS: no significant difference	Estimated blood loss: significantly reduced in sevo group Donor’s anesthetic regimen unknown
Mangus et al. [67]	2018	retrospective	LT 1291 recipients: -392 sevo postC -102 desflurane -797 isoflurane	Incidence of EAD, renal dysfunction, hospital LOS, graft and patient survival: no statistical difference	Nonsignificant increase in ALT in isoflurane group Warm and cold ischemia times significantly higher in isoflurane group MELD and D-MELD significantly higher in sevo group Subgroup analysis for high-risk grafts: no significant difference in peak ALT
Perez-Protto et al. [66]	2018	retrospective	DBD donors 213 organ donors (173 LT): -138 VA preC (59 sevo preC) -75 no VA	Early (30 days) and late (5 years) graft survival: no significant difference Secondary analysis comparing sevo preC and no VA group: no significant difference in early and late graft survival	Recipient’s anesthetic regimen unknown
Li et al. [70]	2019	RCT	Pediatric LDLT 120 recipients: -60 sevo postC -60 propofol (control)	Incidence of AKI, IL-18, TNF-α, NGAL: significantly reduced in sevo postC group IL-10, markers of oxidative stress: no significant difference	Donor’s anesthetic regimen unknown

AKI = acute kidney injury; ALP = alkaline phosphatase; DBD = donation after brain death; EAD= early allograft dysfunction; IC = intermittent clamping; ICU = intensive care unit; iNOS = inducible nitric oxide synthase; INR = international normalized ratio; IPC = ischemic preconditioning; LDLT = living donor liver transplantation; LOS = length of stay; LT = liver transplantation; MELD = model for end-stage liver disease; NGAL = neutrophil gelatinase-associated lipocalin; preC = preconditioning; postC = postconditioning; PRS = postreperfusion syndrome; RCT = randomized controlled trial; sevo = sevoflurane; VA = volatile anesthetic.