Current status of organ preservation with University of Wisconsin solution.
A retrospective analysis of all organs that were preserved with University of Wisconsin solution was undertaken to assess the impact of this solution on early allograft function. From May 1987 until June 1990, 181 livers, 92 pancreata, and 92 kidneys were preserved with University of Wisconsin solution for extended periods of time. The mean (+/- SD) preservation times were as follows: liver, 12.6 +/- 4.5 hours; pancreas, 16.7 +/- 4.4 hours; and kidney, 18.3 +/- 4.3 hours. The overall rate of primary nonfunction and hepatic artery thrombosis were 6.1% and 3.9%, respectively. No differences in the rates of primary nonfunction and hepatic artery thrombosis were noted for combined liver-pancreas procurement vs isolated liver retrievals or when reduced-size liver transplants were compared with nonreduced liver transplants. Likewise, no difference in primary nonfunction or hepatic artery thrombosis was seen in livers that were preserved for less than 6, 6 to 12, and greater than 12 hours. However, serum aminotransferase levels and prothrombin times were lower on the first postoperative day in livers that were preserved for less than 6 hours when compared with 6 to 12 or greater than 12 hours. Early pancreatic allograft function was also excellent for up to 24 hours of cold-storage preservation. All patients were immediately insulin independent, and there were no cases of initial nonfunction or graft pancreatitis. There were only two cases (2.2%) of pancreatic vascular thrombosis in this series. No difference in pancreatic function was noted for organs that were preserved for less than 6, 6 to 12, or greater than 12 hours. Likewise, renal allograft function was excellent, with only two patients (2.2%) requiring postoperative hemodialysis. The actuarial 1-month patient survival for liver and pancreas-kidney transplant recipients was 91.5% and 98.9%, respectively. Actuarial 1-month allograft survival for liver, pancreas, and kidney transplants was 83.0%, 96.7%, and 97.8%, respectively. In conclusion, University of Wisconsin solution represents a significant advancement in cold-storage organ preservation and is ideally suited as a universal intra-abdominal aortic-flush and cold-storage solution.
D'Alessandro
A M
AM
Department of Surgery, University of Wisconsin School of Medicine, Madison.
Kalayoglu
M
M
Sollinger
H W
HW
Pirsch
J D
JD
Southard
J H
JH
Belzer
F O
FO
D000241:Adenosine; D000293:Adolescent; D000493:Allopurinol; D002648:Child; D002675:Child, Preschool; D005978:Glutathione; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D007223:Infant; D007328:Insulin; D016030:Kidney Transplantation; D008099:Liver / Q000502:physiology; D016031:Liver Transplantation; D009926:Organ Preservation; D019188:Organ Preservation Solutions; D010179:Pancreas / Q000502:physiology; D016035:Pancreas Transplantation; D011183:Postoperative Complications; D011887:Raffinose; D012086:Reoperation; D012996:Solutions; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors
D007328:Insulin; D019188:Organ Preservation Solutions; D012996:Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose