The effect of mannitol on oxidation-reduction potential in patients undergoing deceased donor renal transplantation-A randomized controlled trial
Mannitol, an osmotic diuretic, is proposed to be an oxygen radical scavenger. Mannitol is often used in renal transplantation to attenuate oxidative stress and thus to protect renal graft function. We tested the hypothesis that mannitol reduces overall oxidative stress during deceased donor renal transplantation.
METHODS:We randomly assigned 34 patients undergoing deceased donor renal transplantation to receive a solution of mannitol or placebo shortly before graft reperfusion until the end of surgery. We evaluated oxidative stress by measuring the static oxidative-reduction potential (sORP) and the capacity of the oxidative-reduction potential (cORP). sORP and cORP were measured pre-operatively, before and within 10 minutes after graft reperfusion, and post-operatively.
RESULTS:Seventeen patients were enrolled in the mannitol group and 17 patients were enrolled in the placebo group. Mannitol had no significant effect on sORP (148.5 mV [136.2; 160.2]) as compared to placebo (143.6 mV [135.8; 163.2], P = .99). There was also no significant difference in cORP between the mannitol (0.22 µC [0.16; 0.36]) and the placebo group (0.22 µC [0.17; 0.38], P = .76).
CONCLUSION:Mannitol showed no systemic redox scavenging effects during deceased donor renal transplantation. To evaluate the direct effect of mannitol on the renal graft further studies are needed.
TRIAL REGISTRATION:ClinicalTrials.gov NCT02705573.
CET Conclusion
| Reviewer: | Mr John O'Callaghan, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford |
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| Conclusion: | This is a small but well conducted double-blinded RCT in renal transplantation. 34 transplant recipients were randomised to receive a placebo infusion or 1g/Kg infusion of mannitol prior to graft reperfusion. The study size was predicated on results in partial liver resection. Serum markers for oxidative stress were measured using the RedoxSYS Diagnostic System (Aytu Bioscience Inc), which were expressed as Static Oxidative Reduction Potential and Capacity of Oxidative Reduction Potential. There was no significant difference in either of these parameters comparing mannitol to placebo. Unfortunately, the study was not powered to detect clinically relevant outcomes and they are not reported beyond the intra-operative parameters. |
Methodological quality
| Jadad score | 5 |
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| Allocation concealment | YES |
| Data analysis | PER PROTOCOL |
Study Details
| Aims: | This study aimed to investigate whether mannitol was effective in reducing overall oxidative stress in recipients of deceased donor kidney transplants. |
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| Interventions: | Patients were randomly assigned to either the mannitol group or the placebo group. |
| Participants: | 34 patients undergoing deceased donor kidney transplantation. |
| Outcomes: | The primary endpoints were the effect of mannitol on overall static oxidative-reduction potential (sORP) and capacity of the oxidative-reduction potential (cORP). The secondary endpoint was the assessment of percentage change of sORP and cORP values from baseline. |
| Follow Up: | N/A |
Metadata
| Funding: | Funding not described |
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| Publication type: | Randomized Controlled Trial, Randomised Controlled Trial |
| Trial registration: | ClinicalTrials.gov - NCT02705573 |
| Organ: | Kidney |
| Language: | English |
| Author email: | edith.fleischmann@meduniwien.ac.at |
| MeSH terms: | Humans; Kidney; Kidney Transplantation; Mannitol; Oxidation-Reduction; 3OWL53L36A (Mannitol); Deceased Donor Renal Transplantation; Redox Scavenging |