Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study.

Yingqi Chen,Chen Yao,Haiyang Lu,Jia Jiang,Lingdi Hou,Fushan Xue,Wenfei Lv,Xinyu Ning,Ping Chi,Shanshan Mu,Jing Wang,Meixia Shang,Anshi Wu,Shujun Han,Yanxing Zhao,Xu Niu,Yun Yue,Shengnan Li,Sainan Zhu

doi:10.1515/med-2020-0183

Abstract

ObjectivesThis multicenter retrospective study aimed to compare the effects of HES and gelatin (GEL) on the risk of post-OLT AKI.MethodA total of 1,672 patients undergoing OLT were enrolled from major transplant centers in China between 2005 and 2013. These patients were divided into three groups: GEL, hydroxyethyl starch (HES), and GEL + HES group.ResultsThere was no significant difference in the incidence of post-OLT AKI among the GEL, HES, and GEL + HES groups. The GEL + HES group had a lower incidence of stage II post-OLT AKI than the other two groups. Compared with patients receiving GEL, patients receiving HES did not harbor an increased risk of AKI. Our results showed that MELD score (adjusted odds ratio [OR], 1.579; 95% confidence interval [CI], 1.123–2.219; P = 0.009) and preoperative anemia (adjusted OR, 1.533; 95% CI, 1.212–1.939; P < 0.001) were independent risk factors for post-OLT AKI, and normal preoperative Scr level (vs abnormal; adjusted OR, 0.402; 95% CI, 0.222–0.729; P = 0.003) was independent protective factors for post-OLT AKI.ConclusionThis large-scale multicenter retrospective study found that the intraoperative use of HES did not increase the overall incidence of post-OLT AKI in patients when compared with GEL, and whether to increase the risk of post-OLT AKI needs to be further explored.

Highlights

Hydroxyethyl starch (HES) is a plasma substitute widely used for intravascular volume supplement or resuscitation during transplant surgeries [1,2,3,4]
acute kidney injury (AKI) is a common postoperative complication of orthotopic liver transplant (OLT), and its incidence was reported to be more than 50% in post-OLT patients; AKI is associated with prolonged hospitalization and poor prognosis [12,13]
The CRISTAL randomized trial demonstrated that the use of colloids vs crystalloids does not result in significant differences in 28-day mortality and the need for renal replacement therapy in critically ill patients with hypovolemia [19]

Summary

Introduction

Hydroxyethyl starch (HES) is a plasma substitute widely used for intravascular volume supplement or resuscitation during transplant surgeries [1,2,3,4]. A recent systematic review and meta-analysis of randomized controlled trials indicated that HES, compared with crystalloid or other colloidal solutions, may not increase the risk of renal dysfunction in postoperative patients [20]. In post-OLT patients, a small-sample prospective, randomized, controlled clinical trial showed that the intraoperative use of HES as an alternative to human albumin resulted in the equivalent renal outcomes [8]. Another retrospective clinical study found that the intraoperative use of HES significantly increased the risk of post-OLT AKI when compared with albumin, with an odds ratio of 2.94 (95% CI, 1.13–7.7) [11].

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