Cold Heparinized Lactated Ringers With Procaine (HeLP) Preservation Fluid in 266 Living Donor Kidney Transplantations

Abstract

Since the 1960s simple inexpensive cold lactated Ringers with additives has been used for short-term cold preservation of kidneys from living donors. We performed 266 living donor kidney transplantations from January 22, 2003 to October 30, 2006. Donor allografts were recovered laparoscopically and flushed with cold heparin, lactated Ringer's and procaine (HeLP) solution. Warm and cold ischemic times were typically <45 min and <90 min, respectively. The mean follow up was 21.6+/-12.2 months. There was no delayed graft function. Actuarial 1-year patient and graft survival were 98.6% and 98.1%, respectively. The creatinine at 1 year was 1.46+/-0.51 mg/dL. The cumulative incidences of acute cellular rejection at 6, 12, 18, and 24 months were 3.0%, 7.1%, 10.2%, and 11.7%. There were no identifiable side effects attributed to the HeLP solution. This study documents the effectiveness of cold HeLP as a flushing and short-term preservation fluid for living donor kidney transplantation with excellent results and significant cost benefit because of its low cost.

Advances in Kidney Preservation Techniques and Their Application in Clinical Practice

“…In some centers where the CITs are very short, kidneys are simply flushed with a cold crystalloid solution. 77 …”

Preservation solutions for static cold storage of abdominal allografts

“…In total, 610 consecutive deceaseddonor renal transplantations were analyzed with 409 preserved in University of Wisconsin and 201 in Celsior solution. For living-donor kidneys, we flush with cold heparinized lactated Ringers with procaine [35] or HTK solution. No statistically significant difference in 5-year graft survival rates was found for University of Wisconsin solution (90.4%) versus Celsior (93.5%) preservation [31].…”

Efficacy of liver graft washout as a function of the perfusate, pressure, and temperature

“…However, high pressures are associated with increased shear stress, which can lead to endothelial lining perturbations or even affect cellular energy metabolism . These potential complications during washout have been successfully circumvented by the application of Ringer's lactate (RL) as a washout and short‐term preservation solution …”

“…16,17 These potential complications during washout have been successfully circumvented by the application of Ringer's lactate (RL) as a washout and short-term preservation solution. 18,19 Because the aforementioned effects of the perfusate temperature and colloid-induced RBC agglutination during liver washout had not been clarified, this study was designed to quantify RBC retention after liver washout at different temperatures and pressures. First, the agglutination of RBCs was assessed microscopically in perfusates in the presence or absence of colloids.…”