Dextran-induced acute renal failure after microvascular muscle transplantation

Dextrans are a mixture of variously sized glucose polymers that carry a potent osmotic effect. Because of this effect, high- molecular-weight dextrans, which do not pass out of the vessels, have been used for emergency correction of hypovolemia and as a plasma substitute.1,2 Dextrans are used by microsurgeons because they improve microcirculation and decrease thrombosis. These effects are caused by dextran's binding of erythrocytes, platelets, and vascular endothelium, decreasing erythrocyte aggregation and platelet adhesiveness. There are relatively few complications associated with dextran. When these occur, they are usually exaggerations of one or all of the dextran effects, such as volume overload, cerebral edema, pulmonary edema, or platelet dysfunction.1,3-5 A rare but significant complication related to dextran's colloidal effect is acute renal failure. We discuss such a case, its management, and our revised indications for dextran use in microvascular transplantation.