A National Registry Analysis of Kidney Allografts Preserved With Marshall's Solution in the United Kingdom.

Background: The preservation fluids most commonly used for renal allograft preservation in the UK are University of Wisconsin Solution (UW, £120 per liter) and Marshall's Solution (hyperosmolar citrate, £10 per liter). The aim of this study was to compare the outcomes of deceased donor renal allografts preserved with these fluids using data from the UK national transplant registry.

Methods: Data regarding transplants performed between January 1, 2005, and December 31, 2008, was analyzed (n = 5027 kidneys). Kidneys from Donation after Brain Death (DBD) and Donation after Circulatory Death (DCD) were included. After univariate analysis, multivariate logistic and linear regression models were fitted for adult recipients of first grafts (n = 3703 kidneys).

Results: Marshall's solution was associated with longer cold ischemic time, older donors, kidney-only donors, donors with hypertension, and DBD (all P < 0.01). After adjusting for confounding, the choice of preservation fluid was not associated with the risk of PNF (OR, 0.82; 95% CI, 0.46-1.46; P = 0.50), DGF (OR, 1.22; 95% CI, 0.96-1.56; P = 0.11), acute rejection (OR, 0.95; 95% CI, 0.76-1.19; P = 0.63), renal function at 1 year (coefficient, 0.97; 95% CI, 0.91-1.04; P = 0.41), or graft survival (DBD HR, 0.71; 95% CI, 0.46-1.10; P = 12; DCD HR, 0.99; 95% CI, 0.58-1.73; P = 1.00).

Conclusions: Marshall's solution has been used for the preservation of large numbers of kidneys in the UK. It is associated with transplant outcomes that are equivalent to those with UW solution. Thus, on the basis of this analysis and cost, a strong case can be made for the continued use of Marshall's solution as a preferred fluid for renal allograft preservation.