Current Urology Reports

, 20:6 | Cite as

Use of Mannitol for Ischemia Reperfusion Injury in Kidney Transplant and Partial Nephrectomies—Review of Literature

  • Jose Alejandro Lugo-BaruquiEmail author
  • Rajinikanth AyyathuraiEmail author
  • Adavan Sriram
  • Kothai Divya Pragatheeshwar
Kidney Diseases (G Ciancio, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Kidney Diseases


Purpose of Review

Few procedures involve the ischemia-reperfusion injury to organs purposely. Two clear examples in urologic surgery consist on kidney transplantation and partial nephrectomies.

Recent Findings

Mannitol is an osmotic diuretic that is commonly used in partial nephrectomies and kidney transplantation to increase renal blood flow and decrease warm-ischemia-related renal injury to preserve estimated glomerular filtration rate (eGFR).


We review the current evidence for the use of mannitol and its effects on these procedures.


Renal transplant Mannitol Ischemia-reperfusion injury Partial nephrectomy 


Compliance with Ethical Standards

Conflict of Interest

Jose Alejandro Lugo-Baruqui, Rajinikanth Ayyathurai, Adavan Sriram, and Kothai Divya Pragatheeshwar each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Volpe A, Cadeddu JA, Cestari A, Gill IS, Jewett MAS, Joniau S, et al. Contemporary management of small renal masses. Eur Urol. 2011;60:501–15.CrossRefGoogle Scholar
  2. 2.
    Bjurlin MA, Walter D, Taksler GB, Huang WC, Wysock JS, Sivarajan G, et al. National trends in the utilization of partial nephrectomy before and after the establishment of AUA guidelines for the management of renal masses. Urology. 2013;82:1283–90.CrossRefGoogle Scholar
  3. 3.
    • Shawkat H, Westwood M, Mortimer A. Mannitol: a review of its clinical uses. Contin Educ Anaesth Crit Care Pain. 2012;12(2):82–5 Comprehensive pharmacological review of mannitol, itls clinical uses in anesthesiology, and side effects. CrossRefGoogle Scholar
  4. 4.
    Johnston PA, Bernard DB, Perrin NS, Levinsky NG. Prostaglandins mediate the vasodilatory effect of mannitol in the hypoperfused rat kidney. J Clin Invest. 1981;68:127–33.CrossRefGoogle Scholar
  5. 5.
    • Bugge JF, Hartmann A, Osnes S, Bentdal O, Stenstrøm J. Immediate and early renal function after living donor transplantation. Nephrol Dial Transplant. 1999;14(2):389–93 Classic paper that describes normalization of renal function of kidneys transplanted from living donors after volume expansion comb ined with the use of mannitol and furosemide. CrossRefGoogle Scholar
  6. 6.
    P S, van der Woude FJ. Perioperative fluid management in renal transplantation: a narrative review of the literature. Transpl Int. 2006;19(12):947–59.CrossRefGoogle Scholar
  7. 7.
    Cosentino M, Breda A, Sanguedolce F, Landman J, Stolzenburg JU, Verze P, et al. The use of mannitol in partial and live donor nephrectomy: an international survey. World J Urol. 2013;31(4):977–82. Scholar
  8. 8.
    van Valenberg PL, Hoitsma AJ, Tiggeler RG, Berden JH, van Lier HJ, Koene RA. Mannitol as an indispensable constituent of an intraoperative hydration protocol for the prevention of acute renal failure after renal cadaveric transplantation. Transplantation. 1987;44(6):784–8.CrossRefGoogle Scholar
  9. 9.
    Özlülerden Y, Toktaş C, Aybek H, Küçükatay V, Şen Türk N, Zumrutbas AE. Renoprotective effects of mannitol and udenafil in renal ischemia-reperfusion injury model. Investig Clin Urol. 2017;58(4):289–95. Scholar
  10. 10.
    Hanif F, Macrae AN, Littlejohn MG, Clancy MJ, Murio E. Outcome of renal transplantation with and without intra-operative diuretics. Int J Surg. 2011;9:460–3.CrossRefGoogle Scholar
  11. 11.
    Tiggeler RG, Berden JH, Hoitsma AJ, Koene RA. Prevention of acute tubular necrosis in cadaveric kidney transplantation by the combined use of mannitol and moderate hydration. Ann Surg. 1985;201:246–51.CrossRefGoogle Scholar
  12. 12.
    Weimar W, Geerlings W, Bijnen AB, et al. A controlled study on the effect of mannitol on immediate renal function after cadaver donor kidney transplantation. Transplantation. 1983;35:99.PubMedGoogle Scholar
  13. 13.
    Namnesnikov M, Fedorov D, Abu-Gazala S, Weinbroum AA, Khoury W. Mannitol attenuates kidney damage induced by xanthine oxidase-associated pancreas ischemia-reperfusion. J Surg Res. 2010;160(1):163–8.CrossRefGoogle Scholar
  14. 14.
    •• Andrews PM, Cooper M, Verbesey J, Ghasemian S, Rogalsky D, Moody P, et al. Mannitol infusion within 15 min of cross-clamp improves living donor kidney preservation. Transplantation. 2014;98(8):893–7 Classic paper with clinical evidence for the use of mannitol in kidney transplant. CrossRefGoogle Scholar
  15. 15.
    Esfahani HS, Nooraei N, Asgary M, Hashemian MR. The effect of mannitol administration to kidney donor on short-term outcomes of kidney transplantation. Saudi J Kidney Dis Transpl. 2014;25(6):1154–9.CrossRefGoogle Scholar
  16. 16.
    Prerez-Perez AJ, Pazos B, Sobrado J, Gonzalez L, Gandara A. Acute renal failure following massive mannitol infusion. Am J Nephrol. 2002;22:573–5.CrossRefGoogle Scholar
  17. 17.
    Power NE, Maschino AC, Savage C, Silberstein JL, Thorner D, Tarin T, et al. Intraoperative mannitol use does not improve long-term renal function outcomes after minimally invasive partial nephrectomy. Urology. 2012;79:821–6.CrossRefGoogle Scholar
  18. 18.
    Omae K, Kondo T, Takagi T, Iizuka J, Kobayashi H, Hashimoto Y, et al. Mannitol has no impact on renal function after open partial nephrectomy in solitary kidneys. Int J Urol. 2014;21:200–3.CrossRefGoogle Scholar
  19. 19.
    Spaliviero M, Power NE, Murray KS, Sjoberg DD, Benfante NE, Bernstein ML, et al. Intravenous mannitol versus placebo during partial nephrectomy in patients with Normal kidney function: a double-blind, clinically-integrated, randomized trial [Figure presented]. Eur Urol. 2018;73:53–9.CrossRefGoogle Scholar
  20. 20.
    Choi K, Hill S, Hale N, Phillips S, Deem S. Intraoperative mannitol during robotic-assisted-laparoscopic partial nephrectomy. J Robot Surg. 2018; [Internet cited 2018 Oct 13]; Available from: Accessed 31 Aug 2018
  21. 21.
    Novick AC. Renal hypothermia: in vivo and ex vivo. Urol Clin North Am. 1983;10(4):637-44Google Scholar
  22. 22.
    Gelman S. Does mannitol save the kidney? Anesth Analg. 1996;82(5):899-901Google Scholar
  23. 23.
    Cooper CA, Shum CF, Bahler CD, Sundaram CP. Intraoperative mannitol not essential during partial nephrectomy. J Endourol. 2018;32(4):354–8 [Internet cited 2018 Oct 13] Available from: Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jose Alejandro Lugo-Baruqui
    • 1
    Email author
  • Rajinikanth Ayyathurai
    • 2
    Email author
  • Adavan Sriram
    • 2
  • Kothai Divya Pragatheeshwar
    • 3
  1. 1.Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Division of Transplant, Department of SurgeryUniversity of GuadalajaraGuadalajaraMexico
  2. 2.Division of UrologyNortheast Georgia Medical CenterGainesvilleGeorgia
  3. 3.Department of NephrologyUniversity of OklahomaTulsaUSA

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