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

Yingqi Chen; Xinyu Ning; Haiyang Lu; Sainan Zhu; Anshi Wu; Jia Jiang; Shanshan Mu; Jing Wang; Xu Niu; Shengnan Li; Lingdi Hou; Yanxing Zhao; Wenfei Lv; Meixia Shang; Chen Yao; Shujun Han; Ping Chi; Fushan Xue; Yun Yue

doi:10.1515/med-2020-0183

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

Open Med (Wars). 2021 Feb 23;16(1):322-331. doi: 10.1515/med-2020-0183. eCollection 2021.

Authors

Yingqi Chen¹, Xinyu Ning^{1

2}, Haiyang Lu^{1

3}, Sainan Zhu⁴, Anshi Wu¹, Jia Jiang¹, Shanshan Mu¹, Jing Wang¹, Xu Niu², Shengnan Li², Lingdi Hou², Yanxing Zhao⁵, Wenfei Lv⁵, Meixia Shang⁴, Chen Yao⁴, Shujun Han², Ping Chi⁵, Fushan Xue³, Yun Yue¹

Affiliations

¹ Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China.
² Department of Anesthesiology, The Third Medical Centre, Chinese People's Liberation Army General Hospital, No. 69 Yongding Road, Haidian District, Beijing, 100000, China.
³ Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100000, China.
⁴ Department of Biostatistics, Peking University First Hospital, Beijing, 100034, China.
⁵ Department of Anesthesiology, Beijing You'An Hospital, Capital Medical University, No. 8 Xitou Road, You'an Menwai, Fengtai District, Beijing, 100069, China.

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.

Keywords: acute kidney injury; gelatin; hydroxyethyl starch; liver transplantation; risk factors.