{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T02:53:36Z","timestamp":1777949616428,"version":"3.51.4"},"reference-count":47,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:00:00Z","timestamp":1777766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: While liver transplantation (LT) is a definitive treatment for hepatocellular carcinoma (HCC), tumor recurrence remains a major clinical concern. Although volatile anesthetics influence oncological outcomes, direct comparison between sevoflurane and desflurane remains scarce. This study aimed to investigate the impact of the recipient\u2019s volatile anesthetic choice (sevoflurane vs. desflurane) on HCC recurrence following living donor liver transplantation (LDLT). Materials and Methods: This retrospective cohort study included adult patients who underwent LDLT for HCC. Patients were then divided into sevoflurane and desflurane groups, and propensity score matching (PSM) was used to balance baseline variables. The primary outcome was HCC recurrence, and the secondary outcomes were overall survival (OS) and postoperative C-reactive protein (CRP) levels as a marker for the postoperative systemic inflammatory response. Results: After PSM, 373 matched pairs (n = 746) were analyzed. HCC recurrence was significantly higher in the sevoflurane group compared to the desflurane group (19.6% vs. 13.1%, p = 0.023). Kaplan\u2013Meier analysis also demonstrated that cumulative recurrence of HCC was significantly higher in recipients who received sevoflurane anesthesia than in those who received desflurane (log-rank p = 0.0018). In multivariate Cox proportional hazards regression analysis, the use of sevoflurane for anesthesia maintenance was an independent risk factor forHCC recurrence (Hazard Ratio, 1.66; 95% Confidence Interval, 1.15\u20132.39; p = 0.007). Regarding OS, no significant difference was observed between the two groups (log-rank p = 0.1123). Postoperative CRP levels were significantly higher in the sevoflurane group compared to the desflurane group, suggesting a more intense systemic inflammatory response associated with sevoflurane maintenance. Conclusions: For HCC patients undergoing LDLT, anesthesia maintenance with desflurane is associated with a reduced risk of tumor recurrence compared to sevoflurane, without a significant impact on overall survival.<\/jats:p>","DOI":"10.3390\/medicina62050876","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T02:06:21Z","timestamp":1777860381000},"page":"876","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Sevoflurane and Desflurane on Hepatocellular Carcinoma Recurrence After Living Donor Liver Transplantation: A Propensity Score-Matched Analysis"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8599-7097","authenticated-orcid":false,"given":"Hyeun-Joon","family":"Bae","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6082-2474","authenticated-orcid":false,"given":"Sa-Jin","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6643-9177","authenticated-orcid":false,"given":"Kyoung-Sun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hye-Mee","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1225-1793","authenticated-orcid":false,"given":"In-Gu","family":"Jun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6076-6978","authenticated-orcid":false,"given":"Jun-Gol","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3627-1107","authenticated-orcid":false,"given":"Gyu-Sam","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/nrgastro.2016.193","article-title":"Liver transplantation for hepatocellular carcinoma: Outcomes and novel surgical approaches","volume":"14","author":"Sapisochin","year":"2017","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.cgh.2016.11.034","article-title":"Hepatocellular Carcinoma Is the Most Common Indication for Liver Transplantation and Placement on the Waitlist in the United States","volume":"15","author":"Yang","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Bzeizi, K.I., Abdullah, M., Vidyasagar, K., Alqahthani, S.A., and Broering, D. (2022). Hepatocellular Carcinoma Recurrence and Mortality Rate Post Liver Transplantation: Meta-Analysis and Systematic Review of Real-World Evidence. Cancers, 14.","DOI":"10.3390\/cancers14205114"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Tan, D.J.H., Wong, C., Ng, C.H., Poh, C.W., Jain, S.R., Huang, D.Q., and Muthiah, M.D. (2021). A Meta-Analysis on the Rate of Hepatocellular Carcinoma Recurrence after Liver Transplant and Associations to Etiology, Alpha-Fetoprotein, Income and Ethnicity. J. Clin. Med., 10.","DOI":"10.3390\/jcm10020238"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e934924","DOI":"10.12659\/AOT.934924","article-title":"Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models","volume":"27","author":"Stras","year":"2022","journal-title":"Ann. Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.1007\/s00268-015-3129-y","article-title":"Long-Term Outcome After Resection of Huge Hepatocellular Carcinoma \u2265 10 cm: Single-Institution Experience with 471 Patients","volume":"39","author":"Hwang","year":"2015","journal-title":"World J. Surg."},{"key":"ref_7","first-page":"CD008877","article-title":"Anaesthetic techniques for risk of malignant tumour recurrence","volume":"2014","author":"Cakmakkaya","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Choi, H., and Hwang, W. (2024). Anesthetic Approaches and Their Impact on Cancer Recurrence and Metastasis: A Comprehensive Review. Cancers, 16.","DOI":"10.3390\/cancers16244269"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/s12943-019-1058-3","article-title":"Surgical stress and cancer progression: The twisted tango","volume":"18","author":"Chen","year":"2019","journal-title":"Mol. Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Onuma, A.E., Zhang, H., Gil, L., Huang, H., and Tsung, A. (2020). Surgical Stress Promotes Tumor Progression: A Focus on the Impact of the Immune Response. J. Clin. Med., 9.","DOI":"10.3390\/jcm9124096"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.2147\/CMAR.S244280","article-title":"The Role of Inhaled Anesthetics in Tumorigenesis and Tumor Immunity","volume":"12","author":"Xu","year":"2020","journal-title":"Cancer Manag. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1097\/ALN.0b013e3182605df1","article-title":"Volatile anesthetics reduce invasion of colorectal cancer cells through down-regulation of matrix metalloproteinase-9","volume":"117","author":"Bartnicka","year":"2012","journal-title":"Anesthesiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.bja.2023.01.023","article-title":"Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: Follow-up of a multicentre randomised trial","volume":"131","author":"Cao","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.bja.2019.04.057","article-title":"Propofol-based total intravenous anaesthesia is associated with better survival than desflurane anaesthesia in hepatectomy for hepatocellular carcinoma: A retrospective cohort study","volume":"123","author":"Lai","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1097\/ALN.0000000000002357","article-title":"Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery","volume":"129","author":"Wu","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ishikawa, M., Iwasaki, M., Zhao, H., Saito, J., Hu, C., Sun, Q., Sakamoto, A., and Ma, D. (2021). Sevoflurane and Desflurane Exposure Enhanced Cell Proliferation and Migration in Ovarian Cancer Cells via miR-210 and miR-138 Downregulation. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22041826"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6049","DOI":"10.21873\/anticanres.13811","article-title":"Effects of Volatile Anesthetics on Proliferation and Viability of SW480 Colon Cancer Cells In Vitro","volume":"39","author":"Bundscherer","year":"2019","journal-title":"Anticancer Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1097\/SLA.0b013e31818f3dda","article-title":"A randomized controlled trial on pharmacological preconditioning in liver surgery using a volatile anesthetic","volume":"248","author":"Breitenstein","year":"2008","journal-title":"Ann. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19","DOI":"10.14701\/ahbps.2018.22.1.19","article-title":"A cross-sectional analysis of long-term immunosuppressive regimens after liver transplantation at Asan Medical Center: Increased preference for mycophenolate mofetil","volume":"22","author":"Hwang","year":"2018","journal-title":"Ann. Hepatobiliary Pancreat. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"20096","DOI":"10.1038\/s41598-019-56543-3","article-title":"Early postoperative weight gain is associated with increased risk of graft failure in living donor liver transplant recipients","volume":"9","author":"Jeong","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/ajt.12907","article-title":"A complete treatment of adult living donor liver transplantation: A review of surgical technique and current challenges to expand indication of patients","volume":"15","author":"Lee","year":"2015","journal-title":"Am. J. Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zhang, J., Chen, G., Zhang, P., Zhang, J., Li, X., Gan, D., Cao, X., Han, M., Du, H., and Ye, Y. (2020). The threshold of alpha-fetoprotein (AFP) for the diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0228857"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3928","DOI":"10.3748\/wjg.v21.i13.3928","article-title":"Diagnostic value of PIVKA-II and alpha-fetoprotein in hepatitis B virus-associated hepatocellular carcinoma","volume":"21","author":"Seo","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"i71","DOI":"10.1093\/bja\/aet376","article-title":"Update on massive transfusion","volume":"111","author":"Pham","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.jhep.2021.11.018","article-title":"BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update","volume":"76","author":"Reig","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1002\/lt.22365","article-title":"Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience","volume":"17","author":"Mazzaferro","year":"2011","journal-title":"Liver Transpl."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1111\/j.1600-6143.2007.01965.x","article-title":"Liver transplantation for hepatocellular carcinoma: Validation of the UCSF-expanded criteria based on preoperative imaging","volume":"7","author":"Yao","year":"2007","journal-title":"Am. J. Transplant."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1158\/0008-5472.CAN-16-1536","article-title":"Surgery for Cancer: A Trigger for Metastases","volume":"77","author":"Tohme","year":"2017","journal-title":"Cancer Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s10585-018-9896-8","article-title":"Potential impact of invasive surgical procedures on primary tumor growth and metastasis","volume":"35","author":"Alieva","year":"2018","journal-title":"Clin. Exp. Metastasis"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12967-018-1389-7","article-title":"Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence","volume":"16","author":"Kim","year":"2018","journal-title":"J. Transl. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s00595-010-4323-z","article-title":"Immunosuppression following surgical and traumatic injury","volume":"40","author":"Kimura","year":"2010","journal-title":"Surg. Today"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1097\/SLA.0b013e318211d7b5","article-title":"Improving postoperative immune status and resistance to cancer metastasis: A combined perioperative approach of immunostimulation and prevention of excessive surgical stress responses","volume":"253","author":"Goldfarb","year":"2011","journal-title":"Ann. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1056\/NEJM199505183322008","article-title":"The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation","volume":"332","author":"Chrousos","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1007\/s00262-015-1740-2","article-title":"Surgical trauma induces postoperative T-cell dysfunction in lung cancer patients through the programmed death-1 pathway","volume":"64","author":"Xu","year":"2015","journal-title":"Cancer Immunol. Immunother."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"80","DOI":"10.21037\/tgh.2017.09.06","article-title":"Hepatocellular cancer and recurrence after liver transplantation: What about the impact of immunosuppression?","volume":"2","author":"Lerut","year":"2017","journal-title":"Transl. Gastroenterol. Hepatol."},{"key":"ref_36","first-page":"995","article-title":"Sevoflurane inhibits the malignant potential of head and neck squamous cell carcinoma via activating the hypoxia-inducible factor-1\u03b1 signaling pathway in vitro","volume":"41","author":"Yang","year":"2018","journal-title":"Int. J. Mol. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.3346\/jkms.2015.30.10.1503","article-title":"Effect of Propofol and Desflurane on Immune Cell Populations in Breast Cancer Patients: A Randomized Trial","volume":"30","author":"Woo","year":"2015","journal-title":"J. Korean Med. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"26042","DOI":"10.18632\/oncotarget.8304","article-title":"Volatile anaesthetics enhance the metastasis related cellular signalling including CXCR2 of ovarian cancer cells","volume":"7","author":"Iwasaki","year":"2016","journal-title":"Oncotarget"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1093\/bja\/aeu402","article-title":"Sevoflurane promotes the expansion of glioma stem cells through activation of hypoxia-inducible factors in vitro","volume":"114","author":"Shi","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1245\/s10434-014-4112-9","article-title":"Anesthetic selection and disease-free survival following optimal primary cytoreductive surgery for stage III epithelial ovarian cancer","volume":"22","author":"Elias","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_41","first-page":"1331","article-title":"Long-term Effects of Desflurane and Sevoflurane on Mortality and Care Needs in Older Patients after Gastrointestinal Surgery: An Inverse Probability-weighted Analysis","volume":"8","author":"Yoshida","year":"2025","journal-title":"JMA J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.surg.2014.09.009","article-title":"Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: A systematic review","volume":"157","author":"Watt","year":"2015","journal-title":"Surgery"},{"key":"ref_43","first-page":"705","article-title":"Postoperative peak serum C-reactive protein predicts outcome of hepatic resection for hepatocellular carcinoma","volume":"33","author":"Shiba","year":"2013","journal-title":"Anticancer Res."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Meischl, T., Rasoul-Rockenschaub, S., Gyori, G., Sieghart, W., Reiberger, T., Trauner, M., Soliman, T., Berlakovich, G., and Pinter, M. (2019). C-reactive protein is an independent predictor for hepatocellular carcinoma recurrence after liver transplantation. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0216677"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"152","DOI":"10.3109\/1354750X.2015.1118548","article-title":"Postoperative peak serum C-reactive protein is a predictor of outcome following liver transplantation for hepatocellular carcinoma","volume":"21","author":"Kornberg","year":"2016","journal-title":"Biomarkers"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.trecan.2022.07.002","article-title":"Inflammation: The incubator of the tumor microenvironment","volume":"8","author":"Denk","year":"2022","journal-title":"Trends Cancer"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.immuni.2019.06.025","article-title":"Inflammation and Cancer: Triggers, Mechanisms, and Consequences","volume":"51","author":"Greten","year":"2019","journal-title":"Immunity"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/876\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T02:44:40Z","timestamp":1777862680000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,3]]},"references-count":47,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["medicina62050876"],"URL":"https:\/\/doi.org\/10.3390\/medicina62050876","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,3]]}}}