Dexmedetomidine may reduce the odds of delayed graft function following donation-after-cardiac-death (DCD) kidney transplantation, a new study finds.

In a double-blind trial, investigators randomly assigned 64 men and 47 women undergoing DCD kidney transplantation to 24-hour normal saline infusion or dexmedetomidine infusion (0.4 µg/kg/h intraoperatively and 0.1 µg/kg/h postoperatively).

Delayed graft function occurred in a significantly lower proportion of the dexmedetomidine than placebo group (17.9% vs 34.5%). Dexmedetomidine, a selective α2-adrenoreceptor agonist, was significantly associated with 59% decreased odds of delayed graft function, Ke Peng, MD, PhD, of The First Affiliated Hospital of Soochow University in Jiangsu, China, and colleagues reported in JAMA Network Open.

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Dexmedetomidine infusion was also significantly associated with a higher median creatinine clearance rate on postoperative days 1 (9.9 vs 7.9 mL/min) and 2 (29.6 vs 14.6 mL/min), the investigators reported. It led to increased median urine output on postoperative days 2 (106.5 vs 82.9 mL/h) and 7 (126.1 vs 107.0 mL/h) and at hospital discharge (110.4 vs 97.1 mL/h).

No concerning adverse effects occurred with dexmedetomidine, and the drug did not delay postoperative recovery. Within 1 year, graft failure occurred in 3 patients in the placebo group but no one in the dexmedetomidine group.

Delayed graft function can lead to ischemia-reperfusion injury, acute rejection, and reduced graft survival. Dexmedetomidine, however, may be renoprotective by reducing ischemia-reperfusion injury, according to the investigators. The activation of the α2-adrenoreceptor pathway decreases sympathoadrenal hyperactivity in the kidneys and induces vasodilatation, they explained, leading to enhanced glomerular filtration and increased urine output.

“The findings of this trial support the use of dexmedetomidine in kidney transplants,” Dr Peng’s team concluded.


Shan XS, Hu LK, Wang Y, 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. Published online June 3, 2022. doi:10.1001/jamanetworkopen.2022.15217