Mannitol infusion within 15 min of cross-clamp improves living donor kidney preservation.
BACKGROUND
Optical coherence tomography (OCT) revealed that cells lining proximal convoluted tubules of living donor kidneys (LDKs) procured by laparoscopic procedures were very swollen in response to the brief period of ischemia experienced between the time of arterial vessel clamping and flushing the excised kidney with cold preservation solution. Damage to the tubules as a result of this cell swelling resulted in varying degrees of acute tubular necrosis (ATN) that slowed the recovery of the donor kidneys during the first 2 weeks after their transplantation.


METHODS
To prevent this cell damage during LDK procurement, we changed the protocol for intravenous administration of mannitol (i.e., 12.5 or 25 g) to the donor. Specifically, we reduced the time of mannitol administration from 30 to 15 min or less before clamping the renal artery.


RESULTS
OCT revealed that this change in the timing of mannitol administration protected the human donor proximal tubules from normothermic-induced cell swelling. An evaluation of posttransplant recovery of renal function showed that patients treated with this modified protocol returned to normal renal function significantly faster than those treated with mannitol 30 min or more before clamping the renal artery.


CONCLUSIONS
Because slow graft recovery in the first weeks after transplantation represents a risk factor for long-term graft function and survival, we believe that this change in pretreatment protocol will improve renal transplants in patients receiving LDK.
1 Georgetown University Medical Center, Washington, DC. 2 Fischell Department of Bioengineering, University of Maryland, College Park, MD. 3 Address correspondence to: Peter M. Andrews, Ph.D., Georgetown University Medical Center, Washington, DC.
Peter M
PM
Andrews
Matthew
M
Cooper
Jennifer
J
Verbesey
Seyed
S
Ghasemian
Derek
D
Rogalsky
Patrick
P
Moody
Allen
A
Chen
Peter
P
Alexandrov
Hsing-Wen
HW
Wang
Yu
Y
Chen
D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008353:Mannitol / Q000008:administration & dosage*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009926:Organ Preservation / Q000379:methods*; D013997:Time Factors; D009927:Tissue and Organ Procurement
D008353:Mannitol; D003404:Creatinine