Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients.
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.
Cittanova
M L
ML
Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris, France.
Leblanc
I
I
Legendre
C
C
Mouquet
C
C
Riou
B
B
Coriat
P
P
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
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D005780:Gelatin