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围手术期右美托咪定可改善肾移植结局。

Perioperative Dexmedetomidine Improves Outcomes of Kidney Transplant.

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.

Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, California, USA.

出版信息

Clin Transl Sci. 2020 Nov;13(6):1279-1287. doi: 10.1111/cts.12826. Epub 2020 Jun 16.

DOI:10.1111/cts.12826
PMID:32506659
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7719359/
Abstract

Graft function is crucial for successful kidney transplantation. Many factors may affect graft function or cause delayed graft function (DGF), which decreases the prognosis for graft survival. This study was designed to evaluate whether the perioperative use of dexmedetomidine (Dex) could improve the incidence of function of graft kidney and complications after kidney transplantation. A total of 780 patients underwent kidney transplantations, 315 received intravenous Dex infusion during surgery, and 465 did not. Data were adjusted with propensity scores and multivariate logistic regression was used. The primary outcomes are major adverse complications, including DGF and acute rejection in the early post-transplantation phase. The secondary outcomes included length of hospital stay (LOS), infection, overall complication, graft functional status, post-transplantation serum creatinine values, and estimated glomerular filtration rate (eGFR). Dex use significantly decreased DGF (19.37% vs. 23.66%; adjusted odds ratio, 0.744; 95% confidence interval, 0.564-0.981; P = 0.036), risk of infection, risk of acute rejection in the early post-transplantation phase, the risk of overall complications, and LOS. However, there were no statistical differences in 90-day graft functional status or 7-day, 30-day, and 90-day eGFR. Perioperative Dex use reduced incidence of DGF, risk of infection, risk of acute rejection, overall complications, and LOS in patients who underwent kidney transplantation.

摘要

移植物功能对成功的肾移植至关重要。许多因素可能会影响移植物功能或导致延迟移植物功能(DGF),从而降低移植物存活率。本研究旨在评估围手术期使用右美托咪定(Dex)是否可以改善肾移植后移植物功能和并发症的发生率。共有 780 名患者接受了肾移植,315 名患者在手术期间接受了静脉注射 Dex 输注,465 名患者未接受。数据通过倾向评分进行调整,并使用多变量逻辑回归。主要结局是主要不良并发症,包括移植后早期的 DGF 和急性排斥反应。次要结局包括住院时间(LOS)、感染、总并发症、移植物功能状态、移植后血清肌酐值和估算肾小球滤过率(eGFR)。使用 Dex 可显著降低 DGF(19.37% vs. 23.66%;调整后的优势比,0.744;95%置信区间,0.564-0.981;P=0.036)、感染风险、移植后早期急性排斥反应风险、总并发症风险和 LOS。然而,90 天移植物功能状态或 7 天、30 天和 90 天 eGFR 无统计学差异。围手术期使用 Dex 可降低肾移植患者的 DGF 发生率、感染风险、急性排斥反应风险、总并发症风险和 LOS。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/13bb/7719359/c0396c22fb58/CTS-13-1279-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/13bb/7719359/ef403b8645cf/CTS-13-1279-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/13bb/7719359/ef7cd99bdec7/CTS-13-1279-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/13bb/7719359/c0396c22fb58/CTS-13-1279-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/13bb/7719359/ef403b8645cf/CTS-13-1279-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/13bb/7719359/ef7cd99bdec7/CTS-13-1279-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/13bb/7719359/c0396c22fb58/CTS-13-1279-g003.jpg

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Am J Transplant. 2020 Apr;20(4):942-953. doi: 10.1111/ajt.15699. Epub 2019 Dec 11.
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Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis.右美托咪定对围手术期应激、炎症和免疫功能的影响:系统评价和荟萃分析。
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Is It Time for an Expanded Role of Dexmedetomidine in Contemporary Anesthesia Practice? - A Clinician's Perspective.
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Aging (Albany NY). 2023 Dec 11;15(23):14192-14209. doi: 10.18632/aging.205296.
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Inflammasome pathway in kidney transplantation.肾移植中的炎性小体通路。
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