Background: Reperfusion injury and the acid-base status of the transplant are important factors affecting post-transplantation graft function.
Objective: We hypothesized that infusing hypertonic saline (HS) or tight control of acid-base status of the blood rushing through renal graft using sodium bicarbonate may have beneficial effects on early graft function.
Methods: Candidates for deceased-donor kidney transplant were randomized into three groups. HS group (n=33) received 50 mL/kg normal saline (NS) titrated during operation plus 4 mL/kg of 5% HS just within graft reperfusion phase; bicarbonate group (n=37) was administered 60 mL/kg NS while their metabolic acidosis (base excess ≤5 mEq/L) was tightly corrected every 30 min with sodium bicarbonate; and a control group (n=36) that received 60 mL/kg normal saline while they were administered sodium bicarbonate only, if they encountered severe metabolic acidosis (base excess ≤15 mEq/L). The primary outcome was defined as early post-operative renal function evaluated based on serial serum creatinine levels. The study was registered in Iranian Registry of Clinical Trials (IRCT2013122815841N19).
Results: Post-operative early graft function improved significantly during the first 3 days in the intervention groups (p<0.05). However, that beneficial effect no longer remained at the same level after the day four.
Conclusion: Timely administration of HS or tight control of metabolic acidosis with sodium bicarbonate infusion improve early renal function during renal transplant surgery.
Keywords: Acidosis; Bicarbonates; Deceased-donor; Kidney transplantation; Saline solution; hypertonic.
Conflict of interest statement
Effects of tight versus non tight control of metabolic acidosis on early renal function after kidney transplantation.Daru. 2012 Sep 10;20(1):36. doi: 10.1186/2008-2231-20-36. Daru. 2012. PMID: 23351673 Free PMC article.
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- Kosieradzki M, Rowinski W. Ischemia/reperfusion injury in kidney transplantation: mechanisms and prevention. Transplantation proceedings. 2008;40:3279–88. - PubMed
- Chatauret N, Badet L, Barrou B, Hauet T. Ischemia-reperfusion: From cell biology to acute kidney injury. Prog Urol. 2014;24 (Suppl 1):S4–12. - PubMed
- Menke J, Sollinger D, Schamberger B, et al. The effect of ischemia/reperfusion on the kidney graft. Curr Opin Organ Transplant. 2014;19:395–400. - PubMed
- Mikhalski D, Wissing KM, Ghisdal L, et al. Cold ischemia is a major determinant of acute rejection and renal graft survival in the modern era of immunosuppression. Transplantation. 2008;85:S3–9. - PubMed
- Cao Y, Wang L, Chen H, Lv Z. Beneficial effects of hyperosmotic perfusion in the myocardium after ischemia/reperfusion injury in isolated rat hearts. Rev Bras Cir Cardiovasc. 2013;28:54–60. - PubMed