Comparison of the Effects of General Anesthesia and Combined Spinal-Epidural Anesthesia on Ferroptosis, Humanin and MOTS-c Levels in Renal Transplantation

Renal transplantation is the most effective renal replacement therapy for patients with end-stage renal disease. Ischemia-reperfusion injury may adversely affect graft function and long-term outcomes. Ferroptosis has recently emerged as a potential mechanism involved in ischemia-reperfusion injury, while the mitochondrial-derived peptides humanin and MOTS-c are thought to exert protective effects against oxidative stress. However, the effects of different anesthetic techniques on these biomarkers in kidney transplant recipients have not been investigated. This prospective controlled study aims to compare the effects of sevoflurane general anesthesia (SGA) and combined spinal-epidural anesthesia (CSEA) on serum ferroptosis markers, humanin, and MOTS-c levels in adult kidney transplant recipients. Blood samples will be obtained perioperatively for biomarker analysis. The primary objective of the study is to evaluate the effects of the anesthetic technique on serum ferroptosis markers, humanin, and MOTS-c levels. Secondary objectives include evaluating early graft function and postoperative outcomes by assessing the incidence of delayed graft function, postoperative serum creatinine levels, requirement for dialysis, urine output, length of hospital stay, and the association of these outcomes with perioperative biomarker levels.

Inclusion Criteria: * Patients aged 18-70 years with American Society of Anesthesiologists (ASA) physical status I-III. * Patients scheduled for elective living-donor allogeneic kidney transplantation. * Patients receiving sevoflurane-based general anesthesia as the anesthetic technique. * Patients receiving combined spinal-epidural anesthesia as the anesthetic technique. Exclusion Criteria: * Patients younger than 18 years or older than 70 years. * Patients undergoing deceased-donor kidney transplantation. * Patients receiving total intravenous anesthesia (TIVA). * Patients who decline to participate in the study or are unable to provide informed consent. * Patients with American Society of Anesthesiologists (ASA) physical status IV or V. * Patients with a history of previous organ transplantation. * Patients with known or suspected mitochondrial disorders. * Patients with a history of chronic corticosteroid use. * Patients requiring red blood cell transfusion intraoperatively or within the first 24 postoperative hours. * Patients with a primary warm ischemia time \>5 minutes, secondary warm ischemia time \>30 minutes, or cold ischemia time \>60 minutes.