Perioperative effects of dexmedetomidine on renal function in allogeneic kidney transplant patients: a meta-analysis

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 I² 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; I² = 84.1%) and BUN levels (SMD = - 0.87, 95% CI - 1.30 to - 0.44, p = 0.001; I² = 74.5%). Urine output was significantly increased (SMD = 0.98, 95% CI 0.23 to 1.74, p < 0.001; I² = 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; I² = 0.0%). Length of hospital stay was also reduced (SMD = - 0.16, 95% CI - 0.29 to - 0.04, p = 0.364; I² = 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.