Hepatocellular Early Apoptosis Associated with HES 130/0.4 Administration for Volume Replacement in Pigs After Severe Bleeding

Abstract

Hydroxyethyl starch 130/0.4 is a colloid solution used for expanding the plasma volume in situations of severe hypotension that, for example, may result from acute severe blood loss. This volume expansion allows for a more adequate organ perfusion, and consequent oxygen and nutrient delivery to the tissues. Nevertheless, several secondary effects associated with the hydroxyethyl starch 130/0.4 administration have been reported in the scientific literature, mainly when large volumes were used, but its hepatic effect is not clear. In this research, three groups of pigs were used, where just two groups were submitted to acute severe bleeding. In these two groups, volume replacement was either performed with the administration of hydroxyethyl starch 130/0.4 or with Ringer’s lactate. The other group was submitted to the full anaesthetic and monitoring procedures, except for bleeding. After euthanasia, liver samples were collected for histological and immunohistochemical analysis. The liver cells from pigs that had received hydroxyethyl starch 130/0.4 showed significantly early signs of programmed cell death when compared to those that received Ringer’s lactate solution. These findings are of crucial importance when selecting the solution for volume replacement in patients with hepatic disease or that will be submitted to liver transplant.