Intraoperative hydroxyethyl starch 130/0.4 infusion and graft function following donation-after-cardiac-death kidney transplantation

Whether intraoperative hydroxyethyl starch (HES) 130/0.4 infusion affects delayed graft function (DGF) after donation-after-cardiac-death (DCD) kidney transplantation remains uncertain. A cohort of 525 adults (189 with HES infusion and 336 without) undergoing DCD kidney transplantation at a tertiary hospital in China was analyzed. An external validation cohort of 313 patients (120 with HES infusion and 193 without) from another institution was used. Baseline characteristics were well balanced between the HES and non-HES groups after multiple statistical adjustments. The DGF incidence was similar in unadjusted analysis (35% vs. 33%; OR = 1.11; 95% CI, 0.76 to 1.62; <i>p</i> = 0.575) and after adjustments. These findings were consistent in the external cohort. Additionally, intraoperative dopamine use was lower in the HES group (50% vs. 67%; OR = 0.50, 95% CI, 0.35 to 0.72). Intraoperative HES infusion does not influence DGF and was associated with reduced dopamine requirements in DCD kidney transplantation.