Effects of perioperative dexmedetomidine infusion on renal function and microcirculation in kidney transplant recipients: a randomised controlled trial

Abstract

Objective Ischemia-reperfusion injury affects postoperative transplanted kidney function in kidney transplant recipients. Dexmedetomidine was reported to attenuate ischemia-reperfusion injury and improve microcirculation, but its propensity to cause bradycardia and hypotension may adversely affect microcirculation. This study investigated the effect of dexmedetomidine on postoperative renal function and sublingual microcirculation in kidney recipients. Methods The enrolled kidney transplant recipients were randomly allocated to the control group or dexmedetomidine group. After anaesthesia induction, patients in the dexmedetomidine group received dexmedetomidine infusion until 2 h after surgery. Sublingual microcirculation was recorded using an incident dark-field video microscope and analysed. The primary outcomes were the creatinine level on a postoperative day 2 and total vessel density at 2 h after surgery. Results A total of 60 kidney recipients were analysed, and the creatinine levels on postoperative day 2 were significantly lower in the dexmedetomidine group than in the control group (1.5 (1.1–2.4) vs. 2.2 (1.7–3.0) mg/dL, median difference −0.6 (95% CI, −0.7 to −0.5) mg/dL, p = .018). On a postoperative day 7, the creatinine levels did not differ significantly between the two groups. Total vessel density at 2 h after surgery did not differ significantly between the two groups. Conclusion We found that early postoperative renal function was better in kidney transplant recipients receiving dexmedetomidine infusion, but total vessel density was not significantly different between the intervention and control groups. Key messages Ischemia-reperfusion injury affects postoperative transplanted kidney function, and dexmedetomidine was reported to attenuate ischemia-reperfusion injury and improve microcirculation in other clinical conditions. This study showed that early postoperative renal function was better in kidney transplant recipients receiving dexmedetomidine. Dexmedetomidine’s side effect of bradycardia and hypotension may affect microcirculation, our results revealed that the perioperative sublingual microcirculation did not differ significantly in kidney transplant recipients receiving dexmedetomidine.

Renoprotective effect of perioperative dexmedetomidine in kidney transplant patients: systematic review and meta-analysis

“…5 articles were excluded due to review or meeting, case report and different outcome assessed. Four randomized controlled trials (RCTs) with 339 patients and one Propensity Score-adjusted Study involving 780 participants were included [13][14][15][16][17] . The literature search ow diagram shows in Fig.…”

“…Five studies severally undertake from 2020 to 2022 in three countries: South Korea 14 , American 17 and China 13,15,16 . All included studies published in English and dexmedetomidine was administered via intravenous.…”

“…All included studies published in English and dexmedetomidine was administered via intravenous. Three RCTs [13][14][15][16] compared the effects of intravenous dexmedetomidine with saline. One Propensity Score-adjusted Study 17 and one RCT compared received dexmedetomidine with not received dexmedetomidine.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2022

“…However, by POD 7, there was no difference in creatinine levels (1.1 vs 1.3 mg/dL; P = .278). 40 Two other RCTs that compared various perioperative dexmedetomidine infusions to control groups did not find any difference in serum creatinine in the first week after KTx. 41,42 In a fourth study that evaluated the effects of a 24-hour dexmedetomidine infusion in 111 patients (.4 mcg/kg/hr intraoperatively followed by .1 mcg/kg/hr for 24 hours postoperatively), DGF was found to be lower in the dexmedetomidine group (OR .41; CI 0.17-.98, P = .04).…”

“…Intestinal Transplantation Living donor intestine transplant: Wu et al 20 A 22-year multicenter, retrospective cohort of living donor intestine transplants showed positive patient and graft outcomes when recipients and donors had 3 or more HLA matches. Kidney Transplantation Dexmedetomidine: Wang et al, 40 Park et al, 41 Liu et al, 42 Shan et al 43 Dexmedetomidine was not associated with a renal protective effect by POD 7 in three RCTs. ( 51 There was no difference in graft function (creatinine, urea, and eGFR) by POD 5 in kidney transplant patients who received sugammadex compared to neostigmine reversal.…”