Li HX, Cao GZ, Weng YQ, Dong AL, Gao W, Zhu M, Che L, Yu WL. Effects of esketamine on perioperative renal injury in paediatric patients undergoing living donor liver transplantation. World J Gastrointest Surg 2026; 18(6): 119494 [DOI: 10.4240/wjgs.119494]
Corresponding Author of This Article
Wen-Li Yu, Department of Anaesthesiology, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. 5020201005@nankai.edu.cn
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Anesthesiology
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Li HX, Cao GZ, Weng YQ, Dong AL, Gao W, Zhu M, Che L, Yu WL. Effects of esketamine on perioperative renal injury in paediatric patients undergoing living donor liver transplantation. World J Gastrointest Surg 2026; 18(6): 119494 [DOI: 10.4240/wjgs.119494]
World J Gastrointest Surg. Jun 27, 2026; 18(6): 119494 Published online Jun 27, 2026. doi: 10.4240/wjgs.119494
Effects of esketamine on perioperative renal injury in paediatric patients undergoing living donor liver transplantation
Hong-Xia Li, Gui-Zhu Cao, Yi-Qi Weng, Ai-Li Dong, Wei Gao, Min Zhu, Lu Che, Wen-Li Yu
Hong-Xia Li, Department of Anesthesiology, The First Central Hospital of Tianjin Medical University, Tianjin 300192, China
Gui-Zhu Cao, School of Medicine, Nankai University, Tianjin 300071, China
Yi-Qi Weng, Ai-Li Dong, Min Zhu, Lu Che, Wen-Li Yu, Department of Anaesthesiology, Tianjin First Central Hospital, Tianjin 300192, China
Wei Gao, Department of Hepatic Transplantation, Tianjin First Central Hospital, Tianjin 300192, China
Author contributions: Li HX and Cao GZ designed the research, performed the research, analyzed the data, and wrote the manuscript; Weng YQ, Dong AL, Gao W, Zhu M and Che L collected and organized the data, analyzed the data, and implemented quality control; Yu WL supervised the research and revised the manuscript; all authors have read and approved the final manuscript.
Supported by Research Fund for Liquid Therapy in Anesthesiology Medicine, No. YLGX-MZ-2022008; the Tianjin Key Clinical Specialty (Anaesthesiology) Construction Project; and the Tianjin Key Medical Construction Project, No. TJYXZDXK-3-022C.
Institutional review board statement: The study was approved by the Ethics Committee of the Tianjin First Central Hospital (Approval No. KYAP2025-26).
Clinical trial registration statement: This study is registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/index.html). The registration identification number is ChiCTR2500108433.
Informed consent statement: Written informed consent was obtained from the legal guardians of all participants prior to study enrolment.
Conflict-of-interest statement: All authors declare that they have no competing interests.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at 5020201005@nankai.edu.cn.
Corresponding author: Wen-Li Yu, Department of Anaesthesiology, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. 5020201005@nankai.edu.cn
Received: January 29, 2026 Revised: March 4, 2026 Accepted: March 25, 2026 Published online: June 27, 2026 Processing time: 142 Days and 7.8 Hours
Abstract
BACKGROUND
Living-donor liver transplantation (LDLT) is the definitive treatment for end-stage paediatric liver disease; however, acute kidney injury (AKI) occurs in 40%-70% of cases and significantly affects mortality and clinical outcomes. Esketamine has demonstrated anti-inflammatory and organ-protective properties in preclinical studies, but its renoprotective effects in paediatric LDLT have not been established.
AIM
To determine whether intraoperative administration of esketamine reduces perioperative AKI and attenuates the inflammatory response in paediatric LDLT.
METHODS
This randomised, double-blind, placebo-controlled trial was conducted at a tertiary transplant centre in China. Sixty paediatric patients (aged 5-15 months) undergoing LDLT were randomly assigned (1:1) to receive intraoperative esketamine (group E; 0.5 mg/kg at induction followed by 0.5 mg/kg/hour infusion) or placebo (group C). Blood samples were collected at five time points to measure serum creatinine (Scr), tumour necrosis factor, interleukin (IL)-18, IL-10, and neutrophil gelatinase-associated lipocalin (NGAL). Between-group comparisons used independent t-tests or Mann-Whitney U tests.
RESULTS
Group E demonstrated lower Scr at 3 hours post-reperfusion (40.56 ± 15.4 μmol/L vs 60.37 ± 15.4 μmol/L, P < 0.05), 24 hours postoperatively (36.35 ± 8.96 μmol/L vs 58.93 ± 12.57 μmol/L, P < 0.05), and 72 hours postoperatively (34.64 ± 5.66 μmol/L vs 53.51 ± 8.69 μmol/L, P < 0.05). Serum tumour necrosis factor, IL-18, and NGAL levels were also reduced in group E at time points T2-T5 (P < 0.05). Mechanical ventilation duration was shorter in group E (168.55 ± 69.64 minutes vs 264.55 ± 73.64 minutes, P < 0.001).
CONCLUSION
Intraoperative administration of esketamine attenuates the increase in Scr levels following ischemia-reperfusion injury and attenuates the systemic inflammatory response in paediatric LDLT recipients.
Core Tip: This randomized controlled trial demonstrates that, compared with the control group, intraoperative esketamine administration significantly attenuates the increase in serum creatinine levels following ischemia-reperfusion injury and attenuates the systemic inflammatory response in pediatric patients undergoing living donor liver transplantation. The renoprotective effects are mediated by the suppression of tumour necrosis factor-α, interleukin-18, and neutrophil gelatinase-associated lipocalin, alongside hemodynamic stabilization. Esketamine may be considered as a component of anesthetic management to mitigate perioperative renal injury in this high-risk population.
