ArticlesEffect of hydroxyethylstarch in brain-dead kidney donors on 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.
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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 If the family refused consent later, the individual was withdrawn from the study.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
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