Intraoperative mannitol does not prevent renal failure in orthotopic liver transplantation

To undertake a prospective randomised controlled study to investigate whether there is any beneficial renal effect in the perioperative administration of mannitol in patients undergoing orthotopic liver transplantation.

Patients presenting in end-stage liver failure for orthotopic liver transplantation had their preoperative renal function assessed by 24 hour urinary creatinine clearance. In a randomised double-blind study they were allocated to receive either mannitol 0.5 g/kg intravenously, or an equivalent volume of 0.9% saline, after induction. All patients had central venous, peripheral and pulmonary artery catheters inserted and received intravenous fluids, blood and blood products based on central pressure measurements, thromboelastographic monitoring, and blood biochemistry. All patients also received intravenous dopamine 2.5-3.0 microg/kg/min. Intravenous fluids and urine production were recorded intraoperatively and for the first 24 hours in intensive care.

Twenty five patients were enrolled, 13 in the control group and 12 in the mannitol group. There was no significant difference in the preoperative creatinine clearances (control group 72.1 +/- 24.5 mL/min; mannitol group 65.1 +/- 33 mL/min, p = 0.45), total intraoperative fluid requirements (control group 10,741 +/- 4517 mL; mannitol group 13,852 +/- 11,827 mL, p = 0.38) or intraoperative urine production (control group 1323 +/- 1419 mL; mannitol group 912 +/- 493 mL, p = 0.35).

We conclude that intraoperative mannitol does not help preserve renal function in the patient undergoing liver transplantation.