Effect of Perioperative Dexmedetomidine on Delayed Graft Function Following a Donation-After-Cardiac-Death Kidney Transplant: A Randomized Clinical Trial.Shan, X. S., et al.
JAMA Network Open 2022; 5(6): e2215217.
The aim of this study was to compare the incidence of delayed graft function (DGF) among donation-after-cardiac-death (DCD) kidney transplant recipients receiving dexmedetomidine versus normal saline (placebo).
Participants were randomised to receive either dexmedetomidine or normal saline.
114 adults (≥18 years) scheduled for DCD kidney transplant.
The primary endpoint was the incidence of DGF. The secondary endpoints were in-hospital repeated dialysis; in-hospital acute rejection; estimated glomerular filtration rate (eGFR); serum creatinine, serum cystatin C, dialysis requirement, and patient survival.
This is a well-conducted, double-blind randomised controlled trial in DCD renal transplantation. Patients were randomised to receive a peri-operative placebo infusion of saline, or an infusion of dexmedetomidine that was indistinguishable. There were very few withdrawals/dropouts from the study. Delayed Graft Function (DGF) was defined as the need for dialysis in the first week after transplantation and it was significantly reduced in the dexmedetomidine group (18% versus 35%). There was also a significant reduction in repeated dialysis sessions with dexmedetomidine. There was no significant difference in acute rejection rate, graft or patient survival at 1 year, although the study was underpowered for survival outcomes.