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Objectives: Histidine-tryptophan-ketoglutarate (HTK) solution is the storage solution used in organ transplantation. However, such solutions cannot completely eliminate tissue damage. Acetyl L-carnitine (Alcar) is a strong antioxidant. In this study we aimed to determine the protective effects of HTK solution prepared with Alcar in kidney tissue. Methods: Twenty-four rats used in this study were divided into 4 groups. Kidneys of rats in groups 1 and 2 were stored for 4 hours in HTK and HTK+Alcar solutions, respectively. Kidneys of rats in groups 3 and 4 were stored for 24 hours in HTK and HTK+Alcar solutions, respectively. Histological and immunohistochemical examinations of the kidneys were performed. In addition, TUNEL analysis was performed for the evaluation of apoptosis. Results: The findings of histomorphological damage in short-term HTK and HTK+Alcar groups were mild, but it was found widely in long-term HTK and ongterm HTK+Alcar groups on histologic evaluation. When histological scoring was made from kidney sections stained with H&E, the scores in HTK+Alcar groups decreased significantly compared to HTK groups. It was also seen that the score level increased significantly in long-term groups. According to immunohistochemical evaluation, in short- and long-term HTK+Alcar groups, the acetyl-L-carnitine prevented the antiapoptotic mechanisms to be activated and the intense expression of Bcl-2 has not occurred. In short- and long-term HTK groups, osteopontin showed more immunopositive result. Conclusion: It was determined that the modified HTK solution prevented the increase of the activation of the expected oxidant mechanisms resulting in ischemia. This contribution of acetyl-L-carnitine was also found in long-term group findings. [ABSTRACT FROM AUTHOR]