Dexmedetomidine in DCD kidney transplantation
Trial question
What is the role of dexmedetomidine in patients scheduled for a donation-after-cardiac-death kidney transplant?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 111
111 patients (47 female, 64 male).
Inclusion criteria: adult patients scheduled for a donation-after-cardiac death kidney transplant.
Key exclusion criteria: sick sinus syndrome; AV block; LVEF < 30%; multiorgan transplant.
Interventions
N=56 dexmedetomidine (24-hour perioperative intravenous infusion of 0.4 mcg/kg/hr intraoperatively and 0.1 mcg/kg/hr postoperatively).
N=55 placebo (24-hour normal saline infusion with matching infusion rates).
Primary outcome
Rate of need for dialysis in the first posttransplant week
17.9%
34.5%
34.5 %
25.9 %
17.3 %
8.6 %
0.0 %
Dexmedetomidine
Placebo
Significant
decrease ▼
NNT = 6
Significant decrease in the rate of need for dialysis in the first posttransplant week (17.9% vs. 34.5%; OR 0.41, 95% CI 0.17 to 0.98).
Secondary outcomes
Significant decrease in repeated dialysis in the hospital (12.5% vs. 30.9%; OR 0.32, 95% CI 0.13 to 0.88).
No significant difference in mean serum creatinine level at 30 day posttransplant (1.42 mg/dL vs. 1.57 mg/dL; MD -0.15, 95% CI -0.6 to 0.29).
No significant difference in mean eGFR at 30 day posttransplant (65.1 mL/min/1.73 m² vs. 63.3 mL/min/1.73 m²; MD 1.82, 95% CI -7.89 to 11.52).
Conclusion
In adult patients scheduled for a donation-after-cardiac death kidney transplant, dexmedetomidine was superior to placebo with respect to the rate of need for dialysis in the first posttransplant week.
Reference
Xi-Sheng Shan, Lin-Kun Hu, Yiqing Wang et al. Effect of Perioperative Dexmedetomidine on Delayed Graft Function Following a Donation-After-Cardiac-Death Kidney Transplant: A Randomized Clinical Trial. JAMA Netw Open. 2022 Jun 1;5(6):e2215217.
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