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

In France, most of the kidney grafts are obtained from brain dead organ donors. Brain death induces numerous changes, especially in haemodynamic 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 compared two groups of brain dead organ donors and the kidney grafts, differing by the infused solutions : either a combination of HES (Elohes(R), Biosedra) and 4 % human albumin solutions (HES group), or albumin alone in the control group (Albumin group). In the two groups, sex-ratio, age, cause of brain death and duration of therapy were similar. Fluid requirements were identical in the two groups : respectively 2,211 +/- 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 decreased in the HES group : 711 +/- 822 mL (p = 0.0001). Therefore the cost was lower in the latter : 638 +/- 633 vs 1766 +/- 788 FF. The coagulation status was not significantly different between the two groups. Amylasemia was higher in the HES group, but the difference was not significant. In the Albumin group, urinary output increased, but not significantly and creatinemia was decreased : 113.9 +/- 62 vs 131.5 +/- 44 mumol - L-1 (p < 0.05). The two groups. of recipients were also similar for sex-ratio, age, kind of graft, cause of the chronic renal failure and ischaemia times. The lowest creatininemias during the first week were respectively : 167 +/- 127 vs 146 +/- 67 mumol . L-1 (p = 0.55). No dialysis was required. Four renal biopsies in the HES group showed an osmotic nephrosis without any deleterious consequence on the renal function. It is concluded that HES can be used safely for renal harvesting in brain dead patients and that it decreases the cost of organ donation.