Improving Renal Transplant Outcomes through the Tubeless Anesthesia Technique in Renal Transplantation：A retrospective study

Objective To evaluate the feasibility and benefits of tubeless anesthesia (TA), using a laryngeal mask airway instead of endotracheal intubation (ETT), in renal transplantation, aligning with tubeless surgery principles. Methods A single-center, retrospective matched-cohort study compared perioperative outcomes and 90-day graft function between TA and ETT in kidney transplantation. 52 adult recipients (26 TA, 26 ETT) operated between July-December 2024 were included. Groups were balanced for age, BMI, ASA classification, and dialysis duration. The Mann-Whitney U test and T test (SPSS 22.0) were used to analyze the outcome indicators: intraoperative anesthetic management, hemodynamics, recovery parameters, and graft function. Results The TA group required significantly lower median doses of cisatracurium (12.6 mg vs. 26.1 mg; p < 0.001) and sufentanil (22.3 µg vs. 28.7 µg; p = 0.026). Operative times were similar (211.5 min vs. 200.8 min; p = 0.475). Vasoactive agent use was lower in the TA group (53.8% vs. 73.1%; p = 0.211), with fewer requiring dual agents (3.8% vs. 15.4%). TA patients exhibited faster awakening (recovery time: 18.5 min vs. 34.4 min; p < 0.001) and fewer airway complications (7.7% vs. 26.9%; p = 0.070). At 90 days, the TA group had significantly lower serum creatinine (105.6 µmol/L vs. 142.6 µmol/L; p = 0.015). Delayed graft function (15.4% vs. 11.5%; p = 1.000) and early postoperative renal function did not differ significantly. Conclusion Tubeless anesthesia offers perioperative advantages and early graft function benefits in renal transplantation, reducing opioid/muscle relaxant requirements and accelerating recovery. Prospective large-scale studies are warranted to confirm its role in optimizing transplant outcomes. Trial registration: This study is a retrospective study.