Delayed graft function, defined as the need for dialysis within seven days of kidney transplantation, is a common complication affecting deceased-donor kidney transplant recipients. It is associated with prolonged hospitalization, increased healthcare costs, higher rates of acute rejection, and poorer long-term graft survival. Intraoperative diuretics are routinely administered during kidney transplant surgery to promote early urine output and protect the kidney from injury during reperfusion. The two most commonly used agents are furosemide and mannitol. Despite decades of clinical use, no prospective randomized trial has directly compared these two medications, and practice remains highly variable across centres and individual surgeons. This single-centre, prospective, randomized, surgeon-blinded pilot trial will enroll 240 deceased-donor kidney transplant recipients at London Health Sciences Centre. Participants will be randomized in a 1:1 ratio, stratified by donor type, to receive either intraoperative furosemide or intraoperative mannitol. The primary feasibility outcomes include recruitment rate. The primary clinical outcome is the incidence of delayed graft function. Secondary outcomes include serum creatinine trajectory, urine output, dialysis requirements, perioperative complications, length of stay, and one-year graft and patient survival. This pilot trial will provide feasibility data and effect-size estimates necessary to inform the design of a future definitive multicentre randomized controlled trial.
Inclusion Criteria:
Exclusion Criteria:
Cadence.Baker@lhsc.on.ca
In the Furosemide arm, 80 mg IV will be administered at 10-15 minutes prior to reperfusion of the transplanted kidney.
In the Mannitol arm, mannitol 0.5 g/kg IV will be administered at 10-15 minutes prior to reperfusion of the transplanted kidney.
Delayed Renal Allograft Function and Furosemide Treatment
Intraoperative Fluid Therapy for Deceased Donor Renal Transplantation
Preventing Delayed Graft Function in Kidney Transplant Patients
Mannitol Use During Cadaveric Kidney Transplantation
The Effects of Vonoprazan Fumarate on DGF Incidence in DD Kidney Transplant Recipients
Effects of Mannitol on Delayed Graft Function After Cadaveric Renal Transplantation
Intraoperative Dialysis in Liver Transplantation
Furosemide Stress Test Predicting Early Graft Function in Kidney Transplantation