Prevention of acute renal failure after kidney transplantation

Summary The incidence of acute renal failure (ARF) after renal transplantation has always been about 50%. The most important factors for the development of ARF are the hemodynamic condition of the donor, the mode of preservation of the kidney, and the hemodynamic parameters of the recipient. Optimal hydration of the donor and the minimalization of the length of warm ischemia time decreased the incidence of ARF. Further improvement in the incidence of ARF could be achieved either by adding calcium antagonists to the preservation fluid or by using a new preservation fluid (Belzer solution). With moderate hydration of the recipient and the administration of mannitol just before clamp release, we also accomplished a decrease in ARF; however, neither moderate hydration nor mannitol alone could achieve this. By application of these methods, it is now possible after renal transplantation to achieve an incidence of ARF of <20%.