Renoprotective Effect of Intraoperative Dexmedetomidine in Renal Transplantation

Abstract

Background. Renal dysfunction after kidney transplantation may be influenced by many reasons. This study was designed to evaluate whether the administration of dexmedetomidine (Dex) could ameliorate renal function and prognosis after kidney transplantation. Methods. A total of 65 patients were divided into Dex group ( n = 33 ) and Con group (Con, n = 32 ). Dex group intravenously received an initial loading dose of 0.6 μg/kg Dex for 15 min before anaesthesia induction, followed by a rate of 0.4 μg/kg/h until 30 min after kidney reperfusion. By contrast, Con group received saline. The concentration of urinary kidney injury molecule-1 (KIM-1), serum creatinine (Cr), blood urea, urine output, β2 microglobulin (β2-MG), Cystatin C (CysC), and estimated glomerular filtration rate (eGFR) was recorded and compared between two groups during the course of the hospitalization or follow-up. Mean arterial pressure (MAP) and heart rate (HR), vasoactive drugs, and anaesthetics were recorded during the operation. Pain degree was evaluated using a visual analogue scale (VAS) after operation. Delayed graft function (DGF), graft loss, length of hospital stay, and mortality were compared between groups. Results. The concentration of KIM-1 in Dex group was lower than Con group at 2 h ( P = 0.018 ), 24 h ( P = 0.013 ), 48 h ( P < 0.01 ), and 72 h ( P < 0.01 ) after reperfusion. MAP of Dex group after tracheal intubation ( P = 0.012 ) and incision ( P = 0.018 ) and HR after intubation ( P = 0.021 ) were lower than that of Con group. The dosage of sufentanil during operation in Dex group was less than Con group ( P = 0.039 ). Patients that used atropine in Dex group were more than Con group ( P = 0.027 ). Patients who received Dex presented with lower VAS scores at 6 h ( P = 0.01 ) and 12 h ( P = 0.002 ) after operation. Concentration of serum Cr and blood urea had no significant differences between groups before operation and on postoperative day 1 to 6. Urine output was recorded for 6 days after operation and had no differences between groups. Also, no differences were identified between two groups in urea, Cr, β2-MG, CysC, and eGFR in the first 3 months after operation. Incidence of DGF after operation was detected no difference between groups, while length of hospital stay in Dex group was less than Con group ( P = 0.012 ). Conclusion. Dex can decrease kidney injury marker level, attenuate perioperative stress, relieve the dosage of sufentanil and postoperative pain, and reduce length of hospital stay. However, Dex is not associated with changes in prognosis in the first 3 months after transplantation.

Dexmedetomidine for the prevention of delirium in adults admitted to the intensive care unit or post‐operative care unit: A systematic review of randomised clinical trials with meta‐analysis and Trial Sequential Analysis

“…Most of the trials did not report on our outcomes. A total of 106 RCTs and one sub‐study of an included RCT provided data for quantitative synthesis 43–149 . Six of the included trials reported a total of 15 eligible comparisons 60,62,82,124,145,147 .…”

Abdominal Organ Transplantation: Noteworthy Literature in 2022

“…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.…”

“…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). 43 Only one study examined pain control outcomes; the dexmedetomidine group reported lower pain at the six-hour ( P = .01) and 12-hour ( P = .002) marks.…”

“…43 Only one study examined pain control outcomes; the dexmedetomidine group reported lower pain at the six-hour ( P = .01) and 12-hour ( P = .002) marks. 42 While it appears that dexmedetomidine infusions may help with post-operative pain, more studies are needed to determine the effect on IRI as well as evaluate safety outcomes in the immediate post-operative period.…”

Effects of Tai Chi on insomnia in elderly people with chronic non-specific low back pain: A study protocol for a randomized controlled trial

“…The scale ranges from 0 to 10 (Shu and Zhang, 2022), with a higher score indicating greater pain intensity. Participants will be asked to rate their pain weekly before follow-up, and the levels of pain intensity will be categorized as none (0), mild (1-3), moderate (4-6), and severe (7-10) (Liu et al, 2022).…”