Transplant Trial Watch

Effect of dexmedetomidine on the incidence of postoperative acute kidney injury in living donor liver transplantation recipients: A randomized controlled trial.

Kwon, H. M., et al.

International Journal of Surgery 2024 [record in progress].

The aim of this study was to investigate the role of intraoperative dexmedetomidine infusion on the incidence of acute kidney injury (AKI) in living donor liver transplant patients.

Participants were randomised to receive either an infusion of dexmedetomidine or 0.9% saline.

214 living donor liver transplant patients.

The primary endpoint was the incidence of AKI. The secondary endpoints were levels of serial lactate during surgery, overall mortality, graft failure, early allograft dysfunction, major adverse cardiovascular events, chronic kidney disease, duration of mechanical ventilation, intensive care unit (ICU) and hospital length of stay.

3 months posttransplantation

CET Conclusions
This interesting paper from a single centre in South Korea investigated the use of dexmedetomidine (an alpha-2 agonist with anti-inflammatory and anti-oxidant properties) as a renoprotective agent during living-donor liver transplantation. 205 recipients were randomised to dexmedetomidine or control (saline) infusion during surgery. The authors report a significant reduction in risk of acute kidney injury in the dexmedetomidine group (35% vs. 50%), with lower postreperfusion lactate levels, although no difference in incidence of post-reperfusion syndrome. The study appears well designed, with adequate randomisation, allocation concealment and double-blinding. The exact method by which the clinical team were blinded to intervention is unclear – placebo was used, but how this was masked was not described. Given the evidence available from this study and others in cardiac surgery, it certainly warrants further investigation in more mixed multicentre cohorts.

Jadad score

Data analysis
Per protocol analysis

Allocation concealment

Trial registration - NCT03522688

Funding source
Non-industry funded