Total intravenous anesthesia in kidney transplantation: A narrative review

doi:10.5500/wjt.121739

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©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.

World J Transplant. Sep 18, 2026; 16(3): 121739
Published online Sep 18, 2026. doi: 10.5500/wjt.121739

Total intravenous anesthesia in kidney transplantation: A narrative review

Ervandy Rangganata, Juanita Castellanos De Brigard, Apostolos Prionas, Nagy Habib, Vassilios E Papalois

Ervandy Rangganata, Juanita Castellanos De Brigard, Apostolos Prionas, Nagy Habib, Vassilios E Papalois, Department of Surgery and Cancer, Imperial College London, London W12 0HS, United Kingdom

Author contributions: Rangganata E conceived the review, performed the literature search, drafted the manuscript, and led the response to peer review; Castellanos De Brigard J performed the second independent screening and quality appraisal and contributed to the discussion of immunologic implications; Prionas A provided third-reviewer adjudication on study selection and critically reviewed the manuscript; Habib N contributed to the interpretation of mechanistic and surgical-technique aspects; Papalois VE supervised the project, contributed to the framing of clinical priorities, and approved the final manuscript; and all authors approved the submitted and revised versions.

AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.

Conflict-of-interest statement: The authors declare that they have no conflicts of interest, financial or otherwise, relevant to the content of this manuscript. No author has any financial relationship with manufacturers of propofol, volatile anaesthetic agents, target-controlled infusion equipment, or any other product or service discussed in this review. This work received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Ervandy Rangganata, MD, Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0HS, United Kingdom. e.rangganata24@imperial.ac.uk

Received: March 31, 2026
Revised: June 30, 2026
Accepted: July 27, 2026
Published online: September 18, 2026
Processing time: 151 Days and 11.3 Hours

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.

Keywords: Kidney transplantation; Total intravenous anesthesia; Propofol; Volatile anesthesia; Sevoflurane; Ischaemia-reperfusion injury; Delayed graft function; Postoperative recovery

Core Tip: This narrative review compares propofol-based total intravenous anaesthesia (TIVA) with volatile anaesthesia in adult kidney transplantation. Across six comparable studies, TIVA delivers haemodynamic stability and graft function equivalent to volatile maintenance, with reproducible advantages in extubation time and postoperative nausea and vomiting—the latter clinically important for reliable early enteral absorption of immunosuppressants. The biomarker signal of reduced tubular stress under propofol from the VAPOR-1 trial has not translated into measurable clinical benefit in low-risk living-donor cohorts. The next critical step is an adequately powered multicentre randomised trial in extended-criteria-donor and donation-after-circulatory-death recipients, with standardised opioid, fluid, and vasopressor protocols.