Effects of perioperative dexmedetomidine on delayed graft function following renal transplant: a systematic review and meta-analysis
Efeitos da dexmedetomidina perioperatória na função tardia do enxerto após transplante renal: uma revisão sistemática e meta-análise
Ka Ting Ng, Wei En Lim, Wan Yi Teoh, Soo Kun Lim, Ahmad Nazran bin Fadzli, Pui San Loh
Abstract
Background
Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties. Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of this systematic review was to assess whether dexmedetomidine decreases the occurrence of delayed graft function in renal transplant patients.
Methods
Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports.
Results
Ten RCTs involving a total of 1358 patients met the eligibility criteria for data synthesis. Compared to the control group, the dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52–0.97, p = 0.03, GRADE: Very low, I2 = 0%). Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32–11.14, p = 0.003, GRADE: Very low, I2 = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, p < 0.0001, GRADE: Very low, I2 = 0%). The dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, p < 0.00001, GRADE: Very low, I2 = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, p = 0.005, GRADE: Very low, I2 = 87%).
Conclusions
This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.
Keywords
Resumo
Introdução
A dexmedetomidina, um agonista alfa-2 adrenoceptor altamente seletivo com efeitos sedativos e analgésicos, foi sugerida em estudos recentes por possuir propriedades renoprotetoras. A dexmedetomidina pode reduzir a incidência de função tardia do enxerto e contribuir para o controle eficaz da dor pós-transplante renal. O objetivo principal desta revisão sistemática foi avaliar se a dexmedetomidina diminui a ocorrência de função tardia do enxerto em pacientes com transplante renal.
Métodos
Bancos de dados incluindo MEDLINE, EMBASE e CENTRAL foram pesquisados de forma abrangente desde o início até março de 2023. Os critérios de inclusão cobriram todos os Ensaios Clínicos Randomizados (ECRs) e estudos observacionais comparando a dexmedetomidina ao controle em pacientes adultos submetidos à cirurgia de transplante renal. As exclusões compreenderam séries de casos e relatos de casos.
Resultados
Dez ECRs envolvendo um total de 1358 pacientes atenderam aos critérios de elegibilidade para síntese de dados. Comparado ao grupo controle, o grupo dexmedetomidina demonstrou uma incidência significativamente menor de função tardia do enxerto (OR = 0,71, IC de 95% 0,52–0,97, p = 0,03, GRADE: Muito baixo, I2 = 0%). A dexmedetomidina também prolongou significativamente o tempo para o início da analgesia de resgate (MD = 6,73, IC de 95% 2,32–11,14, p = 0,003, GRADE: Muito baixo, I2 = 93%) e reduziu o consumo geral de morfina após o transplante renal (MD = -5,43, IC de 95% -7,95 a -2,91, p < 0,0001, GRADE: Muito baixo, I2 = 0%). O grupo dexmedetomidina apresentou uma redução significativa na frequência cardíaca (MD = -8,15, IC de 95% -11,45 a -4,86, p < 0,00001, GRADE: Muito baixo, I2 = 84%) e pressão arterial média em comparação ao grupo controle (MD = -6,66, IC de 95% -11,27 a -2,04, p = 0,005, GRADE: Muito baixo, I2 = 87%).
Conclusões
Esta meta-análise sugere que a dexmedetomidina pode potencialmente reduzir a incidência de função tardia do enxerto e oferece um perfil de analgesia superior em comparação ao controle em adultos submetidos a transplantes renais. No entanto, o alto grau de heterogeneidade e o tamanho inadequado da amostra ressaltam a necessidade de futuros ensaios com poder adequado para confirmar essas descobertas.
Palavras-chave
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Submitted date:
08/24/2023
Accepted date:
06/19/2024
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