IS HYDROXYETHYL STARCH A CONVENIENT SOLUT ION FOR INTENSIVE THERAPY OF BRAIN-DEAD ORGAN DONORS

In France, most of the kidney grafts are obtained from brain dead orga n donors. Brain death induces numerous changes, especially in haemodyn amic status, requiring the infusion of large volumes of fluid. The aim of this study was to evaluate the effect of hydroxyethyl starch (HES) on the organ donors and the kidney graft function in recipients. We c ompared two groups of brain dead organ donors and the kidney grafts, d iffering by the infused solutions : either a combination of HES (Elohe s(R), Biosedra) and 4 % human albumin solutions (HES group), or albumi n alone in the control group (Albumin group). In the two groups, sex-r atio, age, cause of brain death and duration of therapy were similar. Fluid requirements were identical in the two groups : respectively 2,2 11 +/- 1,512 mL in the Albumin group vs 2,452 +/- 1,094 mL in the HES group (p = 0.17). However, the volume of albumin was significantly dec reased in the HES group : 711 +/- 822 mL (p = 0.0001). Therefore the c ost was lower in the latter : 638 +/- 633 vs 1766 +/- 788 FF. The coag ulation status was not significantly different between the two groups. Amylasemia was higher in the HES group, but the difference was not si gnificant. In the Albumin group, urinary output increased, but not sig nificantly and creatinemia was decreased : 113.9 +/- 62 vs 131.5 +/- 4 4 mumol - L-1 (p < 0.05). The two groups. of recipients were also simi lar for sex-ratio, age, kind of graft, cause of the chronic renal fail ure and ischaemia times. The lowest creatininemias during the first we ek were respectively : 167 +/- 127 vs 146 +/- 67 mumol . L-1 (p = 0.55 ). No dialysis was required. Four renal biopsies in the HES group show ed an osmotic nephrosis without any deleterious consequence on the ren al function. It is concluded that HES can be used safely for renal har vesting in brain dead patients and that it decreases the cost of organ donation.