EFFECT OF HYDROXYETHYLSTARCH IN BRAIN-DEAD KIDNEY DONORS ON RENAL-FUNCTION IN KIDNEY-TRANSPLANT RECIPIENTS

Background Hydroxyethylstarch used as a plasma-volume expander in brai n-dead kidney donors has been suggested to induce osmotic-nephrosis-li ke lesions. We have studied its effect on kidney-transplant function. Methods 52 patients who had received hydroxyethylstarch or iodinated c ontrast-media before brain death were excluded. 69 other brain-dead pa tients 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 inc luded the kidneys in 27 cases (hydroxyethylstarch-gelatin 15, gelatin- only 12). Findings There were no significant differences in the charac teristics of patients between the two groups of kidney donors or of re cipients (except for a small imbalance in sex in the recipients). Duri ng the first 8 days after transplantation, nine of 27 (33%) patients r equired extrarenal haemodialysis or haemodiafiltration in the hydroxye thylstarch-gelatin group compared with one of 20 (5%) in the gelatin-o nly group (p=0.029). Serum creatinine concentrations were significantl y lower in the gelatin-only group than in the other group (p=0.009). 1 0 days after transplantation, mean (SD) serum creatinine was, respecti vely, 145 (70) and 312 (259) mu mol/L. Interpretation These data sugge st that hydroxyethylstarch used as a plasma-volume expander in brain-d ead donors impairs immediate renal function in kidney-transplant recip ients.