title: Hydroxyethyl starch and acute kidney injury in orthotopic liver transplantation: a single-center retrospective review.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a frequent complication of orthotopic liver transplantation (OLT). Hepatic failure pathophysiology and intraoperative events contribute to AKI after OLT. Colloids are routinely used to maintain intravascular volume during OLT. Recent evidence has implicated 6% hydroxyethyl starch (HES) (130/0.4) with AKI in critically ill patients.
  
  
  METHODS
  We performed a retrospective cross-sectional analysis of electronic anesthesia records, surgical dictations, and perioperative laboratory results. Postoperative AKI incidence was determined by RIFLE (Risk Injury Failure Loss End-Stage) criteria. AKI was staged into Risk, Injury, and Failure based on change in serum creatinine from preoperative baseline to peak level by postoperative day 7. Uni- and multivariate analysis was used to evaluate the association between type of intraoperative colloid administered and AKI.
  
  
  RESULTS
  One hundred seventy-four adult patients underwent OLT and had complete records for review. Of these, 50 received only 5% albumin, 25 received both 5% albumin and HES, and 99 received only HES. Albumin-only, albumin and HES, and HES-only groups were otherwise homogeneous based on patient characteristics and intraoperative variables. There was a statistically significant linear-by-linear association between type of colloid(s) administered and AKI (Rifle Criteria-Injury Stage). Patients administered HES were 3 times more likely to develop AKI within 7 days after OLT compared with albumin (adjusted odds ratio 2.94, 95% confidence interval, 1.13-7.7, P = 0.027). The linear trend between colloidal use (5% albumin only versus albumin/HES versus HES only, ranked ordering) and "injury" was statistically significant (P = 0.048). A propensity-matched analysis also showed a significant difference in the incidence of AKI between the patients receiving albumin compared with HES (P = 0.044).
  
  
  CONCLUSIONS
  Patients receiving 6% HES (130/0.4) likely had an increased odds of AKI compared with patients receiving 5% albumin during OLT. These retrospective findings are consistent with recent clinical trials that found an association between 6% HES (130/0.4) and renal injury in critically ill patients.
authors.affiliation: From the Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina; Georgetown University School of Medicine, Washington, DC; Medical University of South Carolina, Charleston, South Carolina; and Department of Public Health Sciences and Division of Transplant Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: William R
authors.initials: WR
authors.lastname: Hand
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Whiteley
authors.forename: Tom I
authors.initials: TI
authors.lastname: Epperson
authors.forename: Lauren
authors.initials: L
authors.lastname: Tam
authors.forename: Heather
authors.initials: H
authors.lastname: Crego
authors.forename: Bethany
authors.initials: B
authors.lastname: Wolf
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Chavin
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000418:Albumins / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D016014:Linear Models; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010952:Plasma Substitutes / Q000009:adverse effects*; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013022:South Carolina; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D015415:Biomarkers; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D003404:Creatinine