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Effects of perioperative dexmedetomidine on delayed graft function following renal transplant: a systematic review and meta-analysis

Ng KT 1 , Lim WE 2 , Teoh WY 3 , Lim SK 4 , Bin Fadzli AN 5 , Loh PS 3

Affiliations 

  • 1 University of Malaya, Department of Anaesthesiology, Kuala Lumpur, Malaysia. Electronic address: katingng1@gmail.com
  • 2 University of Glasgow, Department of Anaesthesiology, Glasgow, United Kingdom
  • 3 University of Malaya, Department of Anaesthesiology, Kuala Lumpur, Malaysia
  • 4 University of Malaya, Department of Medicine, Kuala Lumpur, Malaysia
  • 5 University of Malaya, Department of Surgery, Kuala Lumpur, Malaysia
Braz J Anesthesiol, 2024;74(6):844534.
PMID: 38964607 DOI: 10.1016/j.bjane.2024.844534

Abstract

BACKGROUND: Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties. Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of this systematic review was to assess whether dexmedetomidine decreases the occurrence of delayed graft function in renal transplant patients.

METHODS: Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports.

RESULTS: Ten RCTs involving a total of 1358 patients met the eligibility criteria for data synthesis. Compared to the control group, the dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52-0.97, p = 0.03, GRADE: Very low, I2 = 0%). Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32-11.14, p = 0.003, GRADE: Very low, I2 = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, p < 0.0001, GRADE: Very low, I2 = 0%). The dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, p < 0.00001, GRADE: Very low, I2 = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, p = 0.005, GRADE: Very low, I2 = 87%).

CONCLUSIONS: This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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