Haemodynamic Effect of Dexmedetomidine During Pediatric Kidney Transplantation: A Single-Center Retrospective Study

Abstract

Background Dexmedetomidine is increasingly used for its hemodynamic stability property during general anesthesia. However, there is no data on pediatric kidney transplant recipients (pKTR). Our study investigates the hemodynamic effect of perioperatively administered dexmedetomidine in pKTR. Methods Between 2019 and 2023, all pKTR below 18 years were studied retrospectively at Nantes University Hospital. Intraoperative hemodynamic status was compared between patients who had received dexmedetomidine during kidney transplantation (DEX group) and patients who had not (no-DEX group). Mean arterial pressure (MAP) and heart rate (HR) were monitored throughout the duration of anesthesia and compared. Graft function was assessed by creatinine levels and Glomerular Filtration Rate (GFR) at specific time points. The use of fluid and vasoactive drugs peri-operatively and within 24 hours after surgery was also studied. Results 38 patients were included, 10 in the DEX group et 28 in the no-DEX group. Intraoperative HR was similar between the two groups; however, MAP was significantly higher (mean difference 8, standard deviation [SD: 2–14] mmHg, p = 0,034) in the DEX group. No differences were found regarding the use of fluid and vasoactive drug therapy between groups. Glomerular filtration rate at one month was significantly higher in DEX group (p = 0,009). Conclusion Children receiving intraoperative dexmedetomidine during a KT presented higher perioperative MAP compare to children receiving other sedative agents. DEX group also showed better graft function at one month. The direct impact of dexmedetomidine on immediate post-operative graft function in pTKR should be studied in a prospective multicenter randomized study.