Guo Yong, Lan Gongbin, Hu Shanbiao
Department of Kidney Transplantation, China Clinical Research Center for Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.
Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China.
Int Urol Nephrol. 2025 May 19. doi: 10.1007/s11255-025-04576-1.
Allogeneic kidney transplantation represents a cornerstone therapeutic strategy for patients diagnosed with end-stage renal disease. The perioperative management of these patients plays a crucial role in ensuring both optimal graft viability and favorable postoperative outcomes. Dexmedetomidine, a highly selective α2-adrenergic agonist, has attracted considerable attention for its potential renoprotective properties, which are attributed to its anti-inflammatory effects, suppression of sympathetic nervous activity, and ability to stabilize hemodynamics. This meta-analysis was undertaken to systematically integrate the current body of evidence regarding the impact of dexmedetomidine on perioperative renal function in recipients of allogeneic kidney transplants.
A systematic and comprehensive search of the literature was conducted using multiple databases-PubMed, Embase, Web of Science, Cochrane Library, and the China National Knowledge Infrastructure (CNKI)-up to March 2025. IEligible studies included those involving adult recipients of allogeneic kidney transplants, wherein dexmedetomidine was administered during the perioperative period, and renal function outcomes such as serum creatinine (Cr), blood urea nitrogen (BUN), urine output, or delayed graft function (DGF) were reported. Two reviewers independently extracted data to ensure objectivity and accuracy; disagreements were resolved by discussion. The pooled data were analyzed using a random-effects model. Statistical heterogeneity was quantified using the I statistic, while potential publication bias was assessed through funnel plot symmetry. Sensitivity analyses were conducted to evaluate the robustness of the synthesized results.
Eleven studies comprising 1417 patients were included. Compared to controls, dexmedetomidine significantly reduced serum creatinine levels (SMD = - 0.75, 95% CI - 1.18 to - 0.32, p < 0.001; I = 84.1%) and BUN levels (SMD = - 0.87, 95% CI - 1.30 to - 0.44, p = 0.001; I = 74.5%). Urine output was significantly increased (SMD = 0.98, 95% CI 0.23 to 1.74, p < 0.001; I = 90.0%). The incidence of delayed graft function was lower in the dexmedetomidine group (OR = 0.71, 95% CI 0.52 to 0.97, p = 0.616; I = 0.0%). Length of hospital stay was also reduced (SMD = - 0.16, 95% CI - 0.29 to - 0.04, p = 0.364; I = 5.9%). Sensitivity analyses confirmed the robustness of the results. No significant publication bias was detected.
The results of this meta-analysis support the renoprotective potential of dexmedetomidine when administered during the perioperative phase of allogeneic kidney transplantation. Its use is associated with improvements in key renal function markers, such as reductions in serum creatinine and BUN levels, as well as a decreased incidence of delayed graft function. The observed increase in urine output and shortened hospital stay additionally suggest broader perioperative benefits. Taken together, these findings underscore dexmedetomidine's promise as an adjunct pharmacologic agent in the perioperative care of kidney transplant recipients. Further validation through well-designed, large-scale randomized controlled trials remains essential to inform clinical guidelines.
同种异体肾移植是诊断为终末期肾病患者的基石性治疗策略。这些患者的围手术期管理对于确保移植肾的最佳存活能力和良好的术后结局起着至关重要的作用。右美托咪定是一种高度选择性的α2肾上腺素能激动剂，因其潜在的肾脏保护特性而备受关注，这些特性归因于其抗炎作用、对交感神经活动的抑制以及稳定血流动力学的能力。本荟萃分析旨在系统整合目前关于右美托咪定对同种异体肾移植受者围手术期肾功能影响的证据。
截至2025年3月，使用多个数据库（PubMed、Embase、Web of Science、Cochrane图书馆和中国知网）对文献进行了系统全面的检索。符合条件的研究包括涉及同种异体肾移植成年受者的研究，其中在围手术期给予右美托咪定，并报告了肾功能指标，如血清肌酐（Cr）、血尿素氮（BUN）、尿量或移植肾功能延迟恢复（DGF）。两名审阅者独立提取数据以确保客观性和准确性；分歧通过讨论解决。使用随机效应模型对汇总数据进行分析。使用I统计量对统计异质性进行量化，同时通过漏斗图对称性评估潜在的发表偏倚。进行敏感性分析以评估综合结果的稳健性。
纳入了11项研究，共1417例患者。与对照组相比，右美托咪定显著降低了血清肌酐水平（标准化均数差[SMD]= -0.75，95%置信区间[-1.18至-0.32]，p<0.001；I=84.1%）和BUN水平（SMD= -0.87，95%置信区间[-1.30至-0.44]，p=0.001；I=74.5%）。尿量显著增加（SMD=0.98，95%置信区间[0.23至1.74]，p<0.001；I=90.0%）。右美托咪定组移植肾功能延迟恢复的发生率较低（比值比[OR]=0.71，95%置信区间[0.52至0.97]，p=0.616；I=0.0%）。住院时间也缩短了（SMD= -0.16，95%置信区间[-0.29至-0.04]，p=0.364；I=5.9%）。敏感性分析证实了结果的稳健性。未检测到显著的发表偏倚。
本荟萃分析的结果支持右美托咪定在同种异体肾移植围手术期给药时的肾脏保护潜力。其使用与关键肾功能指标的改善相关，如血清肌酐和BUN水平的降低，以及移植肾功能延迟恢复发生率的降低。观察到的尿量增加和住院时间缩短还表明具有更广泛的围手术期益处。综上所述，这些发现强调了右美托咪定作为肾移植受者围手术期护理辅助药物的前景。通过精心设计的大规模随机对照试验进行进一步验证对于指导临床指南仍然至关重要。
