Addition of adenosine to University of Wisconsin solution: does it help?
ABSTRACT Adenosine Triphosphate (ATP) precursors are sometimes added to preservation solutions in the belief that once the organ is reperfused, these precursors will build up ATP rapidly, returning it to its original metabolic state. This work studied ATP and metabolites during preservation of the rat liver using University of Wisconsin solution (UW), which contains adenosine, versus histidine tryptophan ketaglutarate solution a new phosphate-based preservation solution, or leeds solution (LS), which is under development at our institution (neither of the latter 2 contains adenosine). Tissue samples of perfused livers were analyzed for ATP and metabolites by high-performance liquid chromatography. UW did initially show the expected significant difference in overall adenosine levels, but the advantage had disappeared by 4 hours. At no time did UW show significantly higher levels of ATP; this was not seen following adenosine addition to LS. Only in living donor transplants where the cold ischemic time is short may there be some advantage to the addition of adenosine.
- [Show abstract] [Hide abstract]
ABSTRACT: 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.Transplantation Proceedings 06/2010; 42(5):1531-5. · 0.95 Impact Factor
- Annals of plastic surgery. 09/2014; 73(3):341-342.
- [Show abstract] [Hide abstract]
ABSTRACT: PURPOSE: Animal studies have shown the potential benefits of mannitol as renoprotective during warm ischemia; it may have antioxidant and anti-inflammatory properties and is sometimes used during partial nephrectomy (PN) and live donor nephrectomy (LDN). Despite this, a prospective study on mannitol has never been performed. The aim of this study is to document patterns of mannitol use during PN and LDN. MATERIALS AND METHODS: A survey on the use of mannitol during PN and LDN was sent to 92 high surgical volume urological centers. Questions included use of mannitol, indications for use, physician responsible for administration, dosage, timing and other renoprotective measures. RESULTS: Mannitol was used in 78 and 64 % of centers performing PN and LDN, respectively. The indication for use was as antioxidant (21 %), as diuretic (5 %) and as a combination of the two (74 %). For PN, the most common dosages were 12.5 g (30 %) and 25 g (49 %). For LDN, the most common doses were 12.5 g (36.3 %) and 25 g (63.7 %). Overall, 83 % of centers utilized mannitol, and two (percent or centers??) utilized furosemide for renoprotection. CONCLUSIONS: A large majority of high-volume centers performing PN and LDN use mannitol for renoprotection. Since there are no data proving its value nor standardized indication and usage, this survey may provide information for a randomized prospective study.World Journal of Urology 12/2012; · 2.89 Impact Factor