RCT | Substituting saline with balanced crystalloid solution reduces delayed graft function in kidney transplantation

Summary: The BEST-Fluids study was a pragmatic, multicentre, double-blind, randomized controlled trial carried out across 16 hospitals in Australia and New Zealand, aimed at comparing the use of balanced crystalloid solution (Plasma-Lyte 148) and saline in deceased donor kidney transplantation. The sample size comprised of 808 participants, who were either adults or children of any age, with the primary outcome defined as delayed graft function (DGF) occurring within 7 days post-transplantation.

Findings from the trial revealed that the balanced crystalloid group experienced less DGF than the saline group, with 121 out of 404 participants (30%) and 160 out of 403 participants (40%), respectively. This result yields an adjusted relative risk of 0.74 and an adjusted risk difference of 10.1%.

The study suggests that balanced crystalloid solution significantly reduces the incidence of DGF compared to saline. As no significant safety concerns were raised during the trial, the researchers recommend the use of balanced crystalloid solution as the standard-of-care intravenous fluid in deceased donor kidney transplantation. However, the study doesn’t indicate any significant differences in graft failure or mortality rates, which calls for further research.

Article: Balanced crystalloid solution versus saline in deceased donor kidney transplantation (BEST-Fluids): a pragmatic, double-blind, randomised, controlled trial – The Lancet (free registration required)