title: Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients.
abstract: BACKGROUND
  Hydroxyethylstarch used as a plasma-volume expander in brain-dead kidney donors has been suggested to induce osmotic-nephrosis-like lesions. We have studied its effect on kidney-transplant function.
  
  
  METHODS
  52 patients who had received hydroxyethylstarch of iodinated contrast-media before brain death were excluded. 69 other brain-dead patients were prospectively included over 18 months and randomised into two groups. In the hydroxyethylstarch-gelatin group, patients received hydroxyethylstarch up to 33 mL/kg for colloid plasma-volume expansion, and afterwards received modified fluid gelatin. In the gelatin-only group, patients received only modified fluid gelatin as colloid plasma-volume expander. Multiple organs were procured in 29 cases, which included the kidneys in 27 cases (hydroxyethylstarch-gelatin 15, gelatin-only 12).
  
  
  RESULTS
  There were no significant differences in the characteristics of patients between the two groups of kidney donors or of recipients (except for a small imbalance in sex in the recipients). During the first 8 days after transplantation, nine of 27 (33%) patients required extrarenal haemodialysis or haemodiafiltration in the hydroxyethylstarch-gelatin group compared with one of 20 (5%) in the gelatin-only group (p = 0.029). Serum creatinine concentrations were significantly lower in the gelatin-only group than in the other group (p = 0.009). 10 days after transplantation, mean (SD) serum creatinine was, respectively, 145 (70) and 312 (259) mumol/L.
  
  
  CONCLUSIONS
  These data suggest that hydroxyethylstarch used as a plasma-volume expander in brain-dead donors impairs immediate renal function in kidney-transplant recipients.
authors.affiliation: Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: M L
authors.initials: ML
authors.lastname: Cittanova
authors.forename: I
authors.initials: I
authors.lastname: Leblanc
authors.forename: C
authors.initials: C
authors.lastname: Legendre
authors.forename: C
authors.initials: C
authors.lastname: Mouquet
authors.forename: B
authors.initials: B
authors.lastname: Riou
authors.forename: P
authors.initials: P
authors.lastname: Coriat
mesh_terms: D000328:Adult; D001926:Brain Death; D005260:Female; D005780:Gelatin / Q000494:pharmacology; D017583:Hemodiafiltration; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000494:pharmacology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000502:physiology*; D008297:Male; D009401:Nephrosis / Q000139:chemically induced* / Q000503:physiopathology; D009997:Osmotic Pressure; D010952:Plasma Substitutes / Q000009:adverse effects* / Q000494:pharmacology; D006435:Renal Dialysis; D014019:Tissue Donors
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D005780:Gelatin