Prevention of acute tubular necrosis after transplantation: effect of pretransplantation volume expansion.

We reviewed our experience with 100 consecutive cadaveric transplants of kidneys from satisfactory donors with respect to immediate function after transplantation. The management was the same in all patients except that 66 of them received 1,000 ml of 0.9 N saline IV preoperatively. The overall incidence of acute tubular necrosis (ATN) was 23.2%, but the incidence of ATN in the group of patients who received saline was 7.6%, as compared to 53% in those that did not (P less than .001). There was no other significant difference between the two groups. We conclude that when cadaver kidneys are harvested and preserved under satisfactory conditions, preoperative volume expansion markedly lowers the incidence of posttransplantation ATN, suggesting that the recipient volume status is an important consideration.