Comparison of the novel hydroxyethylstarch 130/0.4 and hydroxyethylstarch 200/0.6 in brain-dead donor resuscitation on renal function after transplantation

Blasco, V.; Léone, Marc; Antonini, François; Geißler, A.; Albanèse, Jacques; Martin, Claude

doi:10.1093/bja/aen001

Cited by 93 publications

(45 citation statements)

References 26 publications

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“…Although a number of previous reports have tried to assess the impact of donor management on recipient kidney graft function (11,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), none of these studies have attempted to standardize donor management on a regional level or evaluate the impact of the prospective implementation of a DMG checklist on DGF. In the current investigation, the impact of meeting such a checklist of DMGs on graft outcomes in deceased donor kidney recipients was prospectively investigated.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

Malinoski¹,

Patel

Ahmed

et al. 2013

American Journal of Transplantation

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Many organ procurement organizations (OPOs) utilize preset critical care endpoints as donor management goals (DMGs) in order to standardize care and improve outcomes. The objective of this study was to determine the impact of meeting DMGs on delayed graft function (DGF) in renal transplant recipients. All eight OPOs of the United Network for Organ Sharing Region 5 prospectively implemented nine DMGs in every donor after neurologic determination of death (DNDD). "DMGs met" was defined a priori as achieving any seven of the nine DMGs and this was recorded at the time of consent for donation to reflect donor hospital ICU management, 12-18 h later, and prior to organ recovery. Multivariable analyses were performed to identify independent predictors of DGF (dialysis in the first week after transplantation) with a p < 0.05. A total of 722 transplanted kidneys from 492 DNDDs were included. A total of 28% developed DGF. DMGs were met at consent in 14%, 12-18 h in 32% and prior to recovery in 38%. DGF was less common when DMGs were met at consent (17% vs. 30%, p = 0.007). Independent predictors of DGF were age, Cr and cold ischemia time, while meeting DMGs at consent was significantly protective. The management of potential organ donors prior to consent affects outcomes and should remain a priority in the intensive care unit.

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Section: Discussionmentioning

confidence: 99%

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

Malinoski¹,

Patel

Ahmed

et al. 2013

American Journal of Transplantation

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“…Several lines of evidence show a difference in microcirculatory oxygenation and renal oxygen consumption between different fluid regimens (38). High-molecular-weight hydroxyethyl starch solutions (≥200 kDa) appear to be deleterious in terms of renal function (203,204); low-molecular-weight starch solutions, on the other hand, may improve renal tissue oxygenation by decreasing blood viscosity (205) and reducing vascular resistance, along with preventing starch molecule accumulation in the renal tubules and the disturbance of glomerular hemodynamics (206). Likewise, because low doses of dopamine are ineffective in terms of prevention or treatment of acute renal failure (201,207), norepinephrine (208) and vasopressin (209) are probably the drugs of choice for improving function in the renal macrocirculation and microcirculation.…”

Section: Therapeutic Implications and Perspectivesmentioning

confidence: 99%

Renal Hypoxia and Dysoxia After Reperfusion of the Ischemic Kidney

Legrand

Mik

Johannes³

et al. 2008

Mol Med

238

169

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Ischemia is the most common cause of acute renal failure. Ischemic-induced renal tissue hypoxia is thought to be a major component in the development of acute renal failure in promoting the initial tubular damage. Renal oxygenation originates from a balance between oxygen supply and consumption. Recent investigations have provided new insights into alterations in oxygenation pathways in the ischemic kidney. These findings have identified a central role of microvascular dysfunction related to an imbalance between vasoconstrictors and vasodilators, endothelial damage and endothelium-leukocyte interactions, leading to decreased renal oxygen supply. Reduced microcirculatory oxygen supply may be associated with altered cellular oxygen consumption (dysoxia), because of mitochondrial dysfunction and activity of alternative oxygen-consuming pathways. Alterations in oxygen utilization and/or supply might therefore contribute to the occurrence of organ dysfunction. This view places oxygen pathways' alterations as a potential central player in the pathogenesis of acute kidney injury. Both in regulation of oxygen supply and consumption, nitric oxide seems to play a pivotal role. Furthermore, recent studies suggest that, following acute ischemic renal injury, persistent tissue hypoxia contributes to the development of chronic renal dysfunction. Adaptative mechanisms to renal hypoxia may be ineffective in more severe cases and lead to the development of chronic renal failure following ischemia-reperfusion. This paper is aimed at reviewing the current insights into oxygen transport pathways, from oxygen supply to oxygen consumption in the kidney and from the adaptation mechanisms to renal hypoxia. Their role in the development of ischemia-induced renal damage and ischemic acute renal failure are discussed.

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“…However, in lung donors, colloid solutions are recommended to minimize accumulation of pulmonary edema and deterioration in gas exchange. 21,84 Although modern, third generation, rapidly degradable HES solutions with a low degree of substitution seem to have less toxic effects on donor kidneys, 85 these HES solutions should be avoided until more documentation is available. Administration of packed red cells to keep the hemoglobin level 100 g/l (or the hematocrit 30%) is recommended, 21,83 but is not evidence based.…”

Section: Hemodynamic Managementmentioning

confidence: 99%

Brain death and its implications for management of the potential organ donor

Bugge

2009

Acta Anaesthesiol Scand

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The systemic physiologic changes that occur during and after brain death affect all organs suitable for transplantation. Major changes occur in the cardiovascular, pulmonary, endocrine, and immunological systems, and, if untreated may soon result in cardiovascular collapse and somatic death. Understanding these complex physiologic changes is mandatory for developing effective strategies for donor resuscitation and management in such a way that the functional integrity of potentially transplantable organs is maintained. This review elucidates these physiological changes and their consequences, and based on these consequences the rationale behind current medical management of brain-dead organ donors is discussed.

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Comparison of the novel hydroxyethylstarch 130/0.4 and hydroxyethylstarch 200/0.6 in brain-dead donor resuscitation on renal function after transplantation

Abstract: Using a modern, third-generation, rapidly degradable HES preparation with a low degree of substitution seems to be associated with a better effect on the renal function of recipients.

Cited by 93 publications

References 26 publications

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

Renal Hypoxia and Dysoxia After Reperfusion of the Ischemic Kidney

Brain death and its implications for management of the potential organ donor

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