Mannitol infusion within 15 min of cross-clamp improves living donor kidney preservation.

MedStar author(s):
Citation: Transplantation. 98(8):893-7, 2014 Oct 27.PMID: 24831920Institution: MedStar Washington Hospital CenterDepartment: UrologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Kidney Transplantation | *Living Donors | *Mannitol/ad [Administration & Dosage] | *Nephrectomy/mt [Methods] | *Organ Preservation/mt [Methods] | Adult | Creatinine/bl [Blood] | Female | Humans | Male | Middle Aged | Time Factors | Tissue and Organ ProcurementLocal holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0041-1337
Name of journal: TransplantationAbstract: 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.CONCLUSION: 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.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.RESULT: 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.All authors: Alexandrov P, Andrews PM, Chen A, Chen Y, Cooper M, Ghasemian S, Moody P, Rogalsky D, Verbesey J, Wang HWDigital Object Identifier: Date added to catalog: 2015-03-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 24831920

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1999 - 2006

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.

CONCLUSION: 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.

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.

RESULT: 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.

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