Hydroxyethyl Starch (130/0.4) for Intravascular Volume Therapy in Liver Transplantation

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00308100
Recruitment Status : Terminated (Study is prematurely ended due to poor patient recruitment rate.)
First Posted : March 29, 2006
Last Update Posted : January 15, 2009
Information provided by:
Fresenius Kabi

Brief Summary:
There are no standardized plasma volume replacement protocols during liver transplantation surgery. The current study is designed to compare efficacy, safety, and costs of perioperative volume replacement with Voluven (Hydroxyethyl starch 130/0.4) and albumin in patients undergoing liver transplantation.

Condition or disease Intervention/treatment Phase
Intraoperative Complications Drug: Hydroxyethylstarch 130/0.4 Drug: 5% Albumin Phase 4

Detailed Description:

End-stage liver disease is one of the major diseases leading to death. With advancement of transplantation surgery and perioperative anesthesia management, liver transplantation has become an effective method to recover patients' liver function, thus saving their lives and improving their quality of life. Serious disorders of fluid balance, such as blood coagulation dysfunction, electrolyte disequilibrium, hypoalbuminaemia, low hematocrit, low hemoglobin and acid-base imbalance etc. exist in end stage cirrhosis patients with liver transplantation. Such abnormalities in the internal milieu could cause or worsen cardiovascular and pulmonary dysfunction, thus making perioperative management more difficult.

Albumin and blood plasma are conventionally used as plasma volume expanders in clinical practice. At the same time, the level of albumin concentration is also used as an important criterion of prognosis. When the level of albumin concentration in serum is below 35 g/L, postoperative mortality rates and complications will increase significantly. In fact, it has been the focus of debate for many years whether albumin should be used for volume replacement in critically ill patients. Boldt and his colleagues demonstrated that albumin has little positive influence on the prognosis of critically ill patients. However, Shwe deemed albumin beneficial to critically ill patients. Simon suggested that albumin is given mainly for treating hypovolemia instead of increasing the level of albumin concentration in serum. However, at the same time, he admitted there is no advantages of albumin in comparison to other colloid solutions and, furthermore, it is more expensive.

Voluven (130/0.4) is a medium molecular weight hydroxyethyl starch (HES) produced by Beijing Fresenius Kabi Pharmaceutical Co., Ltd. It is a novel HES preparation with optimized molecular weight and molecule distribution, has a lower degree of substitution (DS) (0.4), and a narrower molecular distribution profile (C2/C6) than other available HES specifications which make it more suitable for volume replacement therapy. Some studies have revealed that Voluven (130/0.4) has a comparable efficacy with HAES-steril (average molecular weight 200.000 dalton, degree of substitution 0.5). Because of its improved pharmacological profile, Voluven (130/0.4) is used to avoid capillary vessel leakage and improve oxygenation of tissues. In addition, Voluven (130/0.4) does not accumulate in plasma or tissues even after multiple dosing (maximal dose 50 ml/kg), and has an improved HES safety profile in terms of coagulation and kidney function.

The current study is designed to assess the efficacy, safety, and pharmaceutical economics characteristic of perioperative volume replacement with Voluven (130/0.4) in patients undergoing liver transplantation compared with patients who received volume therapy with albumin. The objective of this study is to supply appropriate regimens for patients undergoing liver transplantation, considering clinical efficacy, safety, and costs.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 53 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Multicenter, Randomized, Open-Label, Parallel-Group, Albumin-Controlled Phase IV Study to Evaluate the Efficacy and Safety of Hydroxyethyl Starch (130/0.4) for Intravascular Volume Therapy in Patients Undergoing Liver Transplantation
Study Start Date : October 2005
Actual Primary Completion Date : July 2008
Actual Study Completion Date : July 2008

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: 1 Drug: Hydroxyethylstarch 130/0.4
HES 130/0.4, administered intra- and perioperatively, max. daily dose: 33ml/kg BW; if needed, additionally albumin is administered (ratio crystalloid to colloid= 1:1)
Other Names:
  • HES 130/0.4
  • Hydroxyethyl starch 130/0.4

Active Comparator: 2 Drug: 5% Albumin
5% albumin, administered intra- and perioperatively

Primary Outcome Measures :
  1. Hemodynamics [ Time Frame: From pre-operative period till discharged from hospital ]

Secondary Outcome Measures :
  1. Child-Turcotte-Pugh (CTP) score [ Time Frame: From pre-operative period till discharged from hospital ]
  2. Model for End-Stage Liver Disease (MELD) score [ Time Frame: From pre-operative period till discharged from hospital ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Aged 18-65 years, male or female
  • Elective liver transplantation
  • United Network for Organ Sharing (UNOS) Level 2A/B or 3
  • Serum albumin ≥ 30 g/L
  • Comprehend all the procedures of this study
  • Willing and able to give informed consent

Exclusion Criteria:

  • Uncontrolled exo-hepatic malignant carcinomas
  • Uncontrollable infections (including HIV infection)
  • Need support of artificial liver or kidney, ventilator-dependant, coma or unstable hemodynamically
  • Patients with a history of hypersensitivity to hydroxyethyl starch or albumin
  • Urinary output less than 500 ml within 24 hours after operation
  • Patients with intracranial bleeding
  • Patients with other colloids for treating hypovolemia
  • Patients with pulmonary edema
  • Pregnant women or females of childbearing potential and lactating mothers
  • Patients who are participating in other drug studies or who receive other investigational drugs within 30 days prior to the present study

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00308100

People's Hospital of Peking University
Beijing, China, 100044
Sponsors and Collaborators
Fresenius Kabi
Principal Investigator: Xisheng Leng, MD People's University of Peking University

Responsible Party: Professor Leng Xisheng, Beijing Renmin Hospital Identifier: NCT00308100     History of Changes
Other Study ID Numbers: BFP502
First Posted: March 29, 2006    Key Record Dates
Last Update Posted: January 15, 2009
Last Verified: January 2009

Keywords provided by Fresenius Kabi:
Liver Transplantation

Additional relevant MeSH terms:
Intraoperative Complications
Pathologic Processes
Hydroxyethyl Starch Derivatives
Plasma Substitutes
Blood Substitutes