Association Between Perioperative Dexmedetomidine Exposure and Post-Transplant Renal Outcomes: A Retrospective Analysis

Purpose: Delayed graft function remains a significant complication of kidney transplantation and affects outcomes and healthcare costs. This investigation examined the associations between perioperative dexmedetomidine exposure and postoperative outcomes in kidney transplant recipients. Methods: This retrospective cohort study analyzed data from the TriNetX Research Network of patients who underwent kidney transplantation between January 2014 and December 2024. Adult recipients were stratified according to intraoperative dexmedetomidine exposure. The primary outcome was delayed graft function within seven days post-transplantation. Secondary outcomes included acute rejection, graft failure, infection, mortality, and an estimated glomerular filtration rate (eGFR)< 45 mL/min/1.73 m 2 across multiple time intervals. Results: Following propensity score matching, 3,366 patients were included in each cohort. Dexmedetomidine exposure was associated with a lower incidence of delayed graft function at seven days (22.0% versus 24.7%; odds ratio [OR] 0.86, 95% confidence interval [CI] 0.77– 0.96, p=0.009). More pronounced associations emerged for acute rejection (1.2% vs 3.5%; OR 0.34, 95% CI 0.24– 0.48, p< 0.001) and graft failure (1.6% vs 3.8%; OR 0.42, 95% CI 0.30– 0.57, p< 0.001). These associations persisted through 30 days postoperatively but attenuated progressively thereafter. No significant differences were observed in transplant infection, mortality, or eGFR < 45 mL/min/1.73 m 2 across any time interval. Conclusion: Intraoperative dexmedetomidine exposure was associated with reduced early complications following kidney transplantation. The observational design necessitates cautious interpretation, and randomized controlled trials are required to establish causality. Keywords: dexmedetomidine, kidney transplantation, delayed graft function, acute rejection, graft failure, renoprotection