Effects of Sugammadex Plus Rocuronium vs Neostigmine Plus Cisatracurium During Renal Transplantation on Graft Function: A Retrospective, Case-Control Study

Impact on grafted kidney function of rocuronium-sugammadex vs cisatracurium-neostigmine strategy for neuromuscular block management. An Italian single-center, 2014-2017 retrospective cohort case-control study

“…This study confirmed the advantage of the rocuronium-sugammadex over the cisatracurium-neostigmine strategy not only in improving postoperative kidney function (Vargas et al 2020 ) but also in promoting a better general recovery, independently from the level of NMB at the end of surgery. This may be explained by different impacts of the two reversal drugs on renal function (Munro et al 2004 ; Sorgenfrei et al 2006 ; Flockton et al 2008 ; Staals et al 2011 ; Bostan et al 2011 ; Kip et al 2015 ; Isik et al 2016 ; Büyükfırat et al 2018 ; Vargas et al 2020 ), a restoration of glomerular filtration after surgery that minimizes the stasis of the sugammadex (and rocuronium-sugammadex complex) in the glomeruli and tubules (Bostan et al 2011 ; Kip et al 2015 ; Vargas et al 2020 ), and a potential protective effect of sugammadex against ischemia-reperfusion injury (Vargas et al 2020 ). In an experimental study, sugammadex 16 mg/kg and 100 mg/kg, administered to evaluate the benefit of cyclodextrins against transient global cerebral ischemia, showed a dose-dependent neuroprotective effect in a transient global cerebral ischemia/reperfusion rat model (Ozbilgin et al 2016 ).…”

“…No complications definitely, probably, or possibly related to the reversal drug have been reported (Staals et al 2008 ; Staals et al 2010 ; Cammu et al 2012 ; de Souza et al 2015 ; Panhuizen et al 2015 ). In patients undergoing kidney transplantation, successful use of sugammadex for reversal of moderate rocuronium-induced NMB has been reported by retrospective observational studies (Unterbuchner, 2016 ; Ono et al 2018 ; Arslantas and Cevik, 2019 ; Adams et al 2020 ; Paredes et al, 2020 ; Vargas et al 2020 ). Potential effects of sugammadex, or sugammadex-rocuronium complex, on renal function and the risk of postoperative recurrence of NMB are the main concerns about the rocuronium-sugammadex strategy in subjects with ESRD, including those undergoing kidney transplantation.…”

“…A comparison of the rocuronium-sugammadex and cisatracurium-neostigmine strategies was retrospectively evaluated in kidney transplantation, but the sample size was not large enough to draw a conclusion on the impacts of sugammadex and neostigmine on renal function in such population of patients, and no data are included on sugammadex administered to reverse deep rocuronium-induced NMB (Vargas et al 2020 ). This study confirmed the advantage of the rocuronium-sugammadex over the cisatracurium-neostigmine strategy not only in improving postoperative kidney function (Vargas et al 2020 ) but also in promoting a better general recovery, independently from the level of NMB at the end of surgery.…”

“…A comparison of the rocuronium-sugammadex and cisatracurium-neostigmine strategies was retrospectively evaluated in kidney transplantation, but the sample size was not large enough to draw a conclusion on the impacts of sugammadex and neostigmine on renal function in such population of patients, and no data are included on sugammadex administered to reverse deep rocuronium-induced NMB (Vargas et al 2020 ). This study confirmed the advantage of the rocuronium-sugammadex over the cisatracurium-neostigmine strategy not only in improving postoperative kidney function (Vargas et al 2020 ) but also in promoting a better general recovery, independently from the level of NMB at the end of surgery. This may be explained by different impacts of the two reversal drugs on renal function (Munro et al 2004 ; Sorgenfrei et al 2006 ; Flockton et al 2008 ; Staals et al 2011 ; Bostan et al 2011 ; Kip et al 2015 ; Isik et al 2016 ; Büyükfırat et al 2018 ; Vargas et al 2020 ), a restoration of glomerular filtration after surgery that minimizes the stasis of the sugammadex (and rocuronium-sugammadex complex) in the glomeruli and tubules (Bostan et al 2011 ; Kip et al 2015 ; Vargas et al 2020 ), and a potential protective effect of sugammadex against ischemia-reperfusion injury (Vargas et al 2020 ).…”

“…The safety profile of sugammadex observed in clinical studies involving subjects with severe renal impairment (Staals et al 2008 ; de Souza et al 2015 ) has encouraged its use in clinical practice in patients with ESRD (Adams et al 2020 ; Paredes et al, 2020 ), particularly in those undergoing kidney transplant (Unterbuchner, 2016 ; Ono et al 2018 ; Arslantas and Cevik, 2019 ; Adams et al 2020 ; Vargas et al 2020 ). However, only retrospective analyses including reports (Unterbuchner, 2016 ) or small cohorts of patients are available in the literature (Ono et al 2018 ; Arslantas and Cevik, 2019 ; Adams et al 2020 ; Vargas et al 2020 ). Furthermore, no data exist on the use of sugammadex administered for reversal of deep NMB in patients undergoing kidney transplantation.…”