Elsevier

The Lancet

Volume 348, Issue 9042, 14 December 1996, Pages 1620-1622
The Lancet

Articles
Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients

https://doi.org/10.1016/S0140-6736(96)07588-5Get rights and content

Summary

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 or 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).

Findings

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=0009). 10 days after transplantation, mean (SD) serum creatinine was, respectively, 145 (70) and 312 (259) umol/L

Interpretation

These data suggest that hydroxyethylstarch used as a plasma-volume expander in brain-dead donors impairs immediate renal function in kidney-transplant recipients.

Introduction

Plasma-volume expansion is necessary in brain-dead potential organ donors mainly because of diabetes insipidus, loss of sympathetic tone, and vasoplegia.1, 2, 3 In a retrospective study, low-molecular-weight hydroxyethylstarch used as a plasma-volume expander seemed to cause histological lesions resembling osmotic nephrosis in about 80% of kidney recipients.4 However, the impact of these lesions on transplanted kidney function could not be assessed. We therefore prospectively studied the effects on renal function in kidney-transplant recipients of administering hydroxyethylstarch plus gelatin or gelatin alone to brain-dead potential donors.

Section snippets

Patients and methods

Over 18 months, 121 brain-dead5 patients were diagnosed in our intensive care unit. 52 patients who received hydroxyethylstarch or iodinated contrast-media6 before the diagnosis of brain death were excluded. 69 patients were randomised into two groups (figure 1). This protocol was approved by our local ethics committee. Because of emergency, the family was not informed about randomisation. If the family refused consent later, the individual was withdrawn from the study. No family that agreed to

Results

There were no significant differences in age, sex, cause and duration of brain death, need for dopamine or other inotropic support, and transfusion requirement between the two groups (table 1). Although not significant, more crystalloids and colloids were administered in the gelatin-only group. However, it should be pointed out that hydroxyethylstarch is considered to provide greater volume and duration of plasma expansion than gelatin.11 Moreover, although not significant, the greater

Discussion

In this prospective randomised study we found that administration of hydroxyethylstarch to brain-dead kidney donors worsened the prognosis of renal transplantation. We saw a higher frequency of extrarenal haemodialysis or haemodiafiltration during the first 8 days, and increased serum creatinine during the first 10 days.

Low-molecular weight hydroxyethylstarch was introduced in France in 1991. Its potential toxicity in brain-dead kidney donors for kidney recipients has been suspected since

References (22)

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    Echographic measurements and normal values

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