Long-term outcome in kidney recipients from donors treated with hydroxyethylstarch 130/0.4 and hydroxyethylstarch 200/0.6

Abstract

Editor—In a retrospective study, we compared 57 kidneys recipient patients from brain-dead donors treated with hydroxyethylstarch (HES) 200/0.6 (Elohes®, Fresenius Kabi France, Louviers, France) and 58 recipients from brain-dead donors treated with HES 130/0.4 (Voluven® 6%, Fresenius Kabi, Sèvres, France). As compared with HES 200/0.6, the use of HES 130/0.4 was associated with an improved renal function in recipients.1Blasco V Leone M Antonini F Geissler A Albanèse J Martin C Comparison of the novel hydroxyethylstarch 130/0.4 and hydroxyethylstarch 200/0.6 in brain-dead donor resuscitation on renal function after transplantation.Br J Anaesth. 2008; 100: 504-508Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar At one month post-transplantation, the serum creatinine levels were 133 (38) µmol litre−1 in the kidney recipients from donors treated with HES 130/0.4 and 172 (83) µmol µmol litre−1 in those treated with HES 200/0.6 (P=0.005). A significant difference was still reported one yr post-transplantation (P=0.05). In those patients, we report here the long-term outcome of renal function. Using our electronic database, we collected the serum creatinine levels, the rates of acute rejection, chronic rejection, graft function arrest and death up to seven years post-transplantation. With respect to serum creatinine levels, we included in the final analysis only the recipients with completed data during the entire study period. Statistics were performed using R-Project 3.1 (GNU/Linux Ubuntu 14.10, Vienna, Austria). Proportions were compared using Fischer exact tests and means were compared using Mann-Whitney U-tests. Quantitative data were expressed as means and standard deviations. In order to compare the progression of serum creatinine levels according to time and groups, a generalized linear model was elaborated. Because of the retrospective nature of the study, informed consent and approval by our Institutional Review Board were waived. Seven years post-transplantation, three (2.6%) out of the 115 recipients were lost to follow-up. Death occurred in eight (14%) and five (9%) recipients of the donors treated with HES 200/0.6 and those treated with HES 130/0.4 groups, respectively (P=0.5). The rates of acute rejection (7 vs 2%, P=0.4), chronic rejection (7 vs 12%, P=0.5) and graft function arrest (5 vs 14%, P=0.2) did not differ significantly in both groups. During the seven yr post-transplantation, the serum creatinine levels were higher in the recipients from donors treated with HES 200/0.6 than in those from donors treated with HES 130/0.4 (P=0.01). This difference remained stable during the entire study period (P>0.05) (Table 1).Table 1Serum creatinine levels (µmol litre−1) from yr two to yr seven. HES, hydroxyethylstarch; SD, standard deviationHES 200/0.6HES 130/0.4P-valuenMean (SD)nMean (SD)2 yr57155 (53)48145 (73)0.093 yr52160 (64)42138 (64)0.054 yr50161 (73)40139 (68)0.035 yr48158 (72)38137 (87)0.016 yr44152 (63)34136 (94)0.017 yr42153 (56)32130 (47)0.05 Open table in a new tab In our initial study, the use of HES 130/0.4 was associated with lower serum creatinine levels, in the recipients from donors treated with low molecular weigh HES, than in those treated with high molecular weigh HES. Of note, the volume of crystalloid was significantly increased in the donors treated with HES 130/0.4.1Blasco V Leone M Antonini F Geissler A Albanèse J Martin C Comparison of the novel hydroxyethylstarch 130/0.4 and hydroxyethylstarch 200/0.6 in brain-dead donor resuscitation on renal function after transplantation.Br J Anaesth. 2008; 100: 504-508Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar Our results show that this difference persisted up to seven years post-transplantation. In a randomized controlled trial comparing HES 200/0.6 and gelatin, Cittanova and colleagues2Cittanova ML Leblanc I Legendre C Mouquet C Riou B Coriat P Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients.Lancet. 1996; 348: 1620-1622Abstract Full Text Full Text PDF PubMed Scopus (358) Google Scholar reported a deleterious renal effect of HES 200/0.6 administered in brain-dead kidney donors. In contrast, the 5 yr follow-up of transplanted kidneys between the two groups revealed no difference in serum creatinine levels.3Cittanova ML Mavré J Riou B Coriat P Long-term follow-up of transplanted kidneys according to plasma volume expander of kidney donors.Intensive Care Med. 2001; 27: 1830Crossref PubMed Scopus (23) Google Scholar Our study showed a stable but persisting difference between kidney recipients from donors treated with HES 200/0.6 and those treated with HES 200/0.6. This difference did not clearly affect the patient outcomes. None declared. CorrigendumBritish Journal of AnaesthesiaVol. 116Issue 2PreviewLong-term outcome in kidney recipients from donors treated with hydroxyethylstarch 130/0.4 and hydroxyethylstarch 200/0.6 British Journal of Anaesthesia, 2015; 115(5): 798, DOI 10.1093/bja/aev335 Full-Text PDF Open Archive