Reichert Martin, Willis Franziska, Koch Christian, Amati Anca-Laura, Braun Jacqueline, Weigand Markus A, Sander Michael, Karakizlis Hristos, Schneider Martin, Hecker Andreas
Department of General, Visceral, Thoracic, and Transplant Surgery, University Hospital Giessen, Justus-Liebig-University, Giessen, Germany.
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Justus-Liebig-University, Giessen, Germany.
Int J Surg. 2025 Jun 12;111(9):6374-83. doi: 10.1097/JS9.0000000000002725.
By modulating inflammatory pathways and exerting sympatholytic effects, perioperative dexmedetomidine offers several benefits in non-transplant surgery. Its favorable impact on ischemia-reperfusion injury and perioperative renal function support the potential role of dexmedetomidine as an adjunct in transplant surgery. The evidence within various settings of kidney (KT) and liver transplantation (LT) is systematically reviewed.
This systematic review evaluated randomized controlled trials investigating the efficacy of perioperative systemic dexmedetomidine in preventing allograft failure and/or kidney dysfunction in kidney and liver transplant recipients. Meta-analysis was performed using random or fixed effects model depending on the degree of statistical heterogeneity. Risk of bias and evidence quality were assessed.
Ten randomized controlled trials tested perioperative systemic dexmedetomidine in recipients of living (n = 3) or deceased donor (n = 1) kidney transplants and living (n = 5) or deceased donor (n = 1) liver transplants. With moderate to high certainty, cardiocirculatory, pulmonary or surgical complication rates did not differ between dexmedetomidine and control groups. Risk for delayed graft function was reduced with dexmedetomidine after deceased donor KT (risk ratio:0.52 [0.26-1.01]; p = 0.05) and living donor LT (risk ratio:0.35 [0.17-0.74]; p = 0.006), though this did not translate into improved long-term allograft survival within limited long-term follow-up. Rates of posttransplant acute kidney injury were decreased following these transplant modalities (risk ratio:0.40 [0.18-0.90]; p = 0.03 and 0.69 [0.50-0.95]; p = 0.02, respectively). Early postoperative serum creatinine was improved after KT and living donor LT. After living donor LT, serum parameters indicating allograft function improved with dexmedetomidine on postoperative days 1, 3, and 5. However, no such improvements were observed after deceased donor LT.
Current evidence suggests that perioperative dexmedetomidine may reduce delayed graft function in deceased donor KT and living donor LT while supporting overall renal recovery. However, due to limited data and moderate certainty of evidence, further large-scale multicenter trials are needed to confirm clinical applicability and assess long-term efficacy.
围手术期使用右美托咪定可通过调节炎症途径和发挥抗交感神经作用，在非移植手术中带来诸多益处。其对缺血再灌注损伤和围手术期肾功能的有利影响，支持了右美托咪定在移植手术中作为辅助药物的潜在作用。本研究对肾移植（KT）和肝移植（LT）不同情况下的相关证据进行了系统回顾。
本系统评价纳入了随机对照试验，以研究围手术期全身性使用右美托咪定对预防肾移植和肝移植受者移植物功能衰竭和/或肾功能障碍的疗效。根据统计异质性程度，采用随机效应模型或固定效应模型进行荟萃分析。评估偏倚风险和证据质量。
10项随机对照试验对活体供肾移植（n = 3）或尸体供肾移植（n = 1）受者以及活体供肝移植（n = 5）或尸体供肝移植（n = 1）受者围手术期全身性使用右美托咪定进行了测试。在中到高度确定性下，右美托咪定组和对照组的心血管、肺部或手术并发症发生率无差异。在尸体供肾移植后（风险比：0.52 [0.26 - 1.01]；p = 0.05）和活体供肝移植后（风险比：0.35 [0.17 - 0.74]；p = 0.006），右美托咪定降低了移植肾功能延迟恢复的风险，不过在有限的长期随访中，这并未转化为长期移植物存活率的提高。在这些移植方式后，移植后急性肾损伤的发生率降低（风险比：0.40 [0.18 - 0.90]；p = 0.03和0.69 [0.50 - 0.95]；p = 0.02）。肾移植和活体供肝移植后，术后早期血清肌酐水平得到改善。在活体供肝移植后，术后第1、3和5天，右美托咪定使指示移植物功能的血清参数得到改善。然而，在尸体供肝移植后未观察到此类改善。
目前的证据表明，围手术期使用右美托咪定可能降低尸体供肾移植和活体供肝移植中移植肾功能延迟恢复的风险，同时支持整体肾功能恢复。然而，由于数据有限且证据确定性中等，需要进一步开展大规模多中心试验以确认临床适用性并评估长期疗效。
