Abstract / Summary
Abstract Background Patients with end-stage renal disease frequently present with preoperative electrolyte disturbances and concomitant polypharmacy, factors associated with an increased incidence of postoperative delirium (POD) after allogeneic kidney transplantation. This study aimed to evaluate whether dexmedetomidine reduces the incidence of POD in kidney transplant recipients. Methods This prospective, single-centre, randomised, double-blind, placebo-controlled trial enrolled adult patients undergoing kidney transplantation between January 2018 and December 2021. Participants were randomly assigned in a 1:1 ratio to receive dexmedetomidine 0.4 µg/kg or an equal volume of normal saline immediately after tracheal intubation. The primary outcome was postoperative delirium within the first 5 postoperative days, assessed every 12 h using the Confusion Assessment Method for the Intensive Care Unit. Results A total of 180 participants were randomised into the dexmedetomidine group (DEX, n = 90) and the control group (CON, n = 90). In the primary complete-case analysis of 174 participants, POD occurred in 4 of 88 participants (4.5%) in the DEX group and 13 of 86 participants (15.1%) in the CON group (risk ratio, 0.30; 95% CI, 0.10–0.89; P = 0.019). Acute graft rejection was less frequent in the DEX group than in the CON group (0/88 [0.0%] vs 7/86 [8.1%]; Fisher’s exact P = 0.006). Conclusions Intraoperative dexmedetomidine was associated with a lower incidence of postoperative delirium within 5 days after kidney transplantation, without an observed increase in intraoperative hypotension or bradycardia. Fewer acute graft rejection events were observed in the DEX group, although this exploratory finding requires confirmation. Trial registration ClinicalTrials.gov, NCT02509949. First submitted on 24 July 2015.