The use of mannitol as a protective agent during renal transplantation stems from its ability to increase renal blood flow. This is thought to be due to the release of intrarenal vasodilating prostaglandins and atrial natriuretic peptide (ANP). A second perceived benefit of mannitol is related to its role as an oxygen free-radical scavenger that may impart some protection to the kidney following reperfusion of the renal allograft. Finally, when administered early in the course of acute renal failure (ARF), mannitol tends to flush out cellular debris and prevent tubular cast formation. These actions may convert a patient from oliguric ARF to nonoliguric ARF. A randomized study of hydration with mannitol vs. hydration without mannitol in cadaveric renal transplant demonstrated a significant reduction in postoperative acute tubular necrosis in patients treated with mannitol. However, 3 months after transplantation no difference was found in kidney function. The commonly used dose of mannitol for renal protection is 12.5 to 25 grams. It has become common practice to give mannitol, as well as adequate volume expansion with crystalloid prior to vessel clamp in order to decrease postoperative ATN. The studies cited are all limited, i.e. retrospective, single-center, and/or small number of patients.
R Lauzurica, J Teixidó, A Serra, P Torguet, J Bonet, J Bonal, M Borrás, R Romero, A Caralps Hydration and mannitol reduce the need for dialysis in cadaveric kidney transplant recipients treated with CyA. Transplant. Proc.: 1992, 24(1);46-7
I Porras, J M Gonzalez-Posada, M Losada, A Jordano, V Lorenzo, F Gonzalez-Miranda, F Santolaria, A Torres A multivariate analysis of the risk factors for posttransplant renal failure: beneficial effect of a flush solution with mannitol. Transplant. Proc.: 1992, 24(1);52-3
K F Richards, L P Belnap, W V Rees, L E Stevens Mannitol reduces ATN in cadaveric allografts. Transplant. Proc.: 1989, 21(1 Pt 2);1228-9
R G Tiggeler, J H Berden, A J Hoitsma, R A Koene Prevention of acute tubular necrosis in cadaveric kidney transplantation by the combined use of mannitol and moderate hydration. Ann. Surg.: 1985, 201(2);246-51
P L van Valenberg, A J Hoitsma, R G Tiggeler, J H Berden, H J van Lier, R A Koene Mannitol as an indispensable constituent of an intraoperative hydration protocol for the prevention of acute renal failure after renal cadaveric transplantation. Transplantation: 1987, 44(6);784-8