title: The Impact of Hydroxyethyl Starch Use in Deceased Organ Donors on the Development of Delayed Graft Function in Kidney Transplant Recipients: A Propensity-Adjusted Analysis.
abstract: Our objective was to evaluate the impact of hydroxyethyl starch (HES) use in organ donors after neurologic determination of death (DNDD) on recipient renal graft outcomes. The following data elements were prospectively collected for every DNDD managed by a single organ procurement organization from June 2011 to July 2013: demographics; critical care endpoints; treatments, including the use of HES; graft cold ischemia time (CIT); and the occurrence of recipient delayed graft function (DGF, dialysis in the first week after transplantation). Logistic regression was performed to identify independent predictors of DGF with a p-value <0.05. The results were then adjusted for each donor's calculated propensity to receive HES. Nine hundred eighty-six kidneys were transplanted from 529 donors. Forty-two percent received HES (1217 ± 528 mL) and 35% developed DGF. Kidneys from DNDDs who received HES had a higher crude rate of DGF (41% vs. 31%, p < 0.001). After accounting for the propensity to receive HES, independent predictors of DGF were age (OR 1.02 [1.01-1.04] per year), CIT (OR 1.04[1.02-1.06] per hour), creatinine (OR 1.5 [1.32-1.72] per mg/dL) and HES use (OR 1.41 [1.02-1.95]). HES use during donor management was independently associated with a 41% increase in the risk of DGF in kidney transplant recipients.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: M S
authors.initials: MS
authors.lastname: Patel
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.|Department of Surgery, University of California San Francisco, San Francisco, CA.
authors.forename: C U
authors.initials: CU
authors.lastname: Niemann
authors.affiliation: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR.|Department of Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: M B
authors.initials: MB
authors.lastname: Sally
authors.affiliation: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR.|Department of Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: S
authors.initials: S
authors.lastname: De La Cruz
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX.
authors.forename: J
authors.initials: J
authors.lastname: Zatarain
authors.affiliation: School of Medicine, University of California, Davis, Sacramento, CA.
authors.forename: T
authors.initials: T
authors.lastname: Ewing
authors.affiliation: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR.
authors.forename: M
authors.initials: M
authors.lastname: Crutchfield
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: C K
authors.initials: CK
authors.lastname: Enestvedt
authors.affiliation: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR.|Department of Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: D J
authors.initials: DJ
authors.lastname: Malinoski
mesh_terms: D000328:Adult; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D014019:Tissue Donors
chemical_list: D006895:Hydroxyethyl Starch Derivatives
keywords: donors and donation; donors and donation: donation after brain death (DBD)