Modified perfusion fluid for renal transplantation in developing countries: our initial experience

Organ preservation is an important step in transplantation. Perfusion fluid plays a vital role in this matter. As in many other developing countries, perfusion fluid is not readily available and is costly. Alternatively, the commonly used Hartmann's solution does not have preservation quality. Hence, to meet the demand, a modified perfusion fluid was prepared following standard preservative flush principles.

Hartmann's solution was modified by adding potassium chloride, magnesium sulfate, mannitol, dexamethasone, and insulin. The whole process was performed under aseptic conditions. The final composition was a hypertonic solution similar to Marshall's solution.

Upon use in 14 renal transplantation operations we observed the modified solution to be protective for kidney storage for more than 4 hours, namely, a mean cold ischemia time of 187.50 +/- 30.58 minutes (range 156-254 minutes). There was no apparent deterioration in posttransplantation graft function. All 14 grafts worked from the operative day with a mean creatinine reduction rate in the first 24 hours of 198.90 +/- 46.12 mumol/L and mean serum creatinine level at 21 days of 138.70 +/- 16.16 mumol/L. These results were not significantly different from those achieved with Collin's solution.

A modified perfusion fluid was effective, cheaper, and easy to prepare; therefore it is suitable for transplantation in developing countries.