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

Abstract

Objectives This multicenter retrospective study aimed to compare the effects of HES and gelatin (GEL) on the risk of post-OLT AKI. Method A 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. Results There 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. Conclusion This 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.

The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study

“…Both colloids and crystalloids can be used in GDFT protocol. Previous studies showed that intraoperative colloid usage was not associate with an increased risk of AKI after cardiac surgery [31], liver transplantation surgery [32], and thoracoscopic lobectomy [22]. Meta-analysis showed that postoperative kidney dysfunction was similar between colloid-based GDFT and crystalloid-based GDFT after major noncardiac surgery [33].…”

The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study

“…Though HES has adverse effect in severe sepsis patients and intensive care patients (Perner et al 2012 ; Myburgh et al 2012 ), but the pathophysiology was different between sepsis and operation patients. A study of 11,691 patients who underwent elective noncardiac surgeries showed that the intraoperative use of moderate doses of 6% HES 130/0.4 was not associated with increased risk of AKI (Degoul et al 2020 ), as while as in cardiac surgery (Nagore et al 2021 ) and liver transplantation surgery (Chen et al 2021 ). The recent meta-analysis also showed that HES was shown to be safe and efficacious in the perioperative setting (Chappell et al 2021 ).…”