ArticleTransplantation direct2026
Ringer Lactate Versus Hybrid Isotonic/Hypotonic Saline in Delayed Graft Function in Deceased-donor Kidney Transplantation: A Real-world Protocol Change Study.
Article in Transplantation direct, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
4 authors.
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Abstract
Background: Delayed graft function (DGF) remains a major complication after deceased-donor kidney transplantation. Balanced crystalloid solutions have been associated with lower DGF incidence compared with 0.9% saline, largely based on strategies using Plasma-lyte. However, the role of Ringer lactate compared with other low-chloride solutions, such as hypotonic saline, remains unclear. We therefore evaluated whether a protocol-driven change in perioperative crystalloid strategy was associated with DGF and early posttransplant kidney function. Methods: We conducted a retrospective, single-center, quasi-experimental study including recipients of deceased-donor kidney transplants. Patients were exposed to a protocol-driven change in perioperative hydration from a hybrid intraoperative 0.9% saline plus postoperative hypotonic saline (0.45%) strategy to an intraoperative and postoperative Ringer's lactate strategy. The primary outcome was DGF. Secondary outcomes included DGF duration, longitudinal kidney function, electrolyte trajectories, and 12-mo clinical outcomes. Generalized additive mixed models were used to evaluate longitudinal trajectories of graft function and electrolyte balance while accounting for within-subject variability. Results: A total of 257 kidney transplant recipients were included (142 Ringer lactate; 115 hybrid isotonic/hypotonic saline), with comparable baseline characteristics. DGF incidence did not differ between groups (47.9% Ringer lactate versus 52.2% hybrid isotonic/hypotonic; Conclusions: In this real-world quasi-experimental study, Ringer lactate was not associated with lower DGF incidence or duration compared with a hybrid isotonic/hypotonic saline-based strategy. No differences were also observed in graft function over the 12-mo follow-up. These findings support further investigation into whether differences in chloride exposure may influence early graft outcomes.
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