Emerging Perspectives in TransplantationIschemia reperfusion injuryInfluence of Hydroxyethyl Starch on Renal Function After Orthotopic Liver Transplantation

- HES200/0.5 or 130/0.4 have no significant effect on renal function after OLT.
- Old age, low platelet level, and massive RBC transfusion are risk factors for RI.
- Postoperative renal impairment requires longer ICU stay.

BackgroundPostoperative renal impairment (RI) is one of the most common complications in orthotopic liver transplantation (OLT), and it occurs in 17% to 95% of the patients who undergo the surgery.MethodsWe reviewed 394 consecutive patients who underwent OLT. On the basis of the preoperative renal function level (presence of renal failure (RF): SCr >1.5 mg/dL before OLT), the patients were divided into an RF group and a non-RF group. In each group, the patients were subdivided into 4 subgroups according to the type and dosage of the intra-operative use of HES (hydroxyethyl starch). The changing tendency of the SCr (serum creatinine) of each group and the ratio of the change in the SCr within the first postoperative week were compared.ResultsIn total, 139 of 394 patients (35%) had RI within the first week after OLT (RI group); 104 patients (75%) in the RI group and 181 patients (71%) in the non-RI group required HES transfusions. The multivariate logistic regression analysis identified old age, a low pre-operative platelet level, and massive red blood cell transfusions as risk factors for the postoperative development of RI. The changing tendency of the SCr and the ratio of change in the SCr among the different HES subgroups showed no significant difference in the RF group or in the non-RF group.ConclusionsPerioperative use of HES 200/0.5 or HES 130/0.4 has no significant effect on renal function in the first postoperative week in patients undergoing OLT.