{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T12:34:24Z","timestamp":1793363664695,"version":"4.5.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background.<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods.<\/jats:title>\n                    <jats:p>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\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results.<\/jats:title>\n                    <jats:p>\n                      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;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005=\u20050.49), nor did days to renal graft recovery (5.7 versus 5.7 d;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005=\u20050.96) or DGF duration (10.5 versus 10.2 d;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005=\u20050.78). Mortality, graft loss, and biopsy-proven rejection at 12 mo were also similar. In covariate-adjusted longitudinal analyses, the estimated glomerular filtration rate did not differ between groups. Electrolyte trajectories showed modest differences between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions.<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/txd.0000000000001978","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:31:44Z","timestamp":1783009904000},"page":"e1978","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Ringer Lactate Versus Hybrid Isotonic\/Hypotonic Saline in Delayed Graft Function in Deceased-donor Kidney Transplantation: A Real-world Protocol Change Study"],"prefix":"10.1097","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9556-3604","authenticated-orcid":false,"given":"Arthur Gus","family":"Manfro","sequence":"first","affiliation":[{"name":"Kidney Transplant Unit, Hospital de Cl\u00ednicas de Porto Alegre, Rio Grande do Sul, Brazil."},{"name":"Postgraduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanderlei Carlos","family":"Bertuol Junior","sequence":"additional","affiliation":[{"name":"Kidney Transplant Unit, Hospital de Cl\u00ednicas de Porto Alegre, Rio Grande do Sul, Brazil."},{"name":"Postgraduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda Correa","family":"da Silva Alves","sequence":"additional","affiliation":[{"name":"Kidney Transplant Unit, Hospital de Cl\u00ednicas de Porto Alegre, Rio Grande do Sul, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Carla","family":"Bauer","sequence":"additional","affiliation":[{"name":"Kidney Transplant Unit, Hospital de Cl\u00ednicas de Porto Alegre, Rio Grande do Sul, Brazil."},{"name":"Postgraduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."},{"name":"Department of Internal Medicine, School of Medicine\u2014Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"R1-20261030","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1038\/ki.2014.18","article-title":"Delayed kidney graft function: from mechanism to translation.","volume":"86","author":"Schr\u00f6ppel","year":"2014","journal-title":"Kidney Int"},{"key":"R2-20261030","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1093\/ndt\/gfn667","article-title":"Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis.","volume":"24","author":"Yarlagadda","year":"2009","journal-title":"Nephrol Dial 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History"}},{"value":"2026-05-27","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}