Eurotransplant randomized multicenter kidney graft preservation study comparing HTK with UW and Euro-Collins.
The aim was to evaluate the effect of HTK compared to UW and Euro-Collins (EC) on the initial graft function and long term graft survival in two prospective randomized studies. Only kidneys from heart-beating, kidney-only or kidney + heart donors were eligible for entry. Initial non-function (INF) was defined as the absence of life-sustaining renal function, requiring dialysis treatment on two or more occasions, during the first week after transplantation. To evaluate the contribution of the preservation solutions on INF in relation to other factors, a multivariate, 2-step logistic regression model was used. Randomization was performed between July 1990 and September 1992. The UW-HTK study comprised 342 donors and 611 transplants (UW: 168 donors and 297 transplants, HTK: 174 donors and 314 transplants). In the EC-HTK study 317 donors and 569 transplants were included (EC: 155 donors and 277 transplants, HTK: 162 donors and 292 transplants). INF occurred in 33% of either HTK-(n = 105) or UW-(n = 99) preserved kidneys (P = NS), and in 29% of the HTK-(n = 85) and in 43% of the EC-(n = 119) preserved kidneys (P = 0.001). Multivariate analysis showed no significant influence of the preservation solution on the incidence of INF in the UW-HTK study, but factors contributing to INF were donor age, cause of death, retransplantation, and cold ischemic period. The EC-HTK study showed a significantly higher risk of INF, using EC as preservation, in addition to cold ischemic period and donor quality. The 3-year graft survival of HTK-preserved kidneys was 73%, compared to 68% for UW-preserved kidneys in the UW-HTK study (P = NS); while the 3-year graft survival of HTK preserved kidneys was 70% compared to 67% for EC-preserved kidneys in the EC-HTK study (P = NS). We can conclude that HTK is comparable to UW in its preservative abilities, using kidneys from heart-beating kidney-only donors, whereas EC as renal preservation solution should be avoided.
de Boer
J
J
Eurotransplant International Foundation, Leiden, The Netherlands. jdeboer@eurotransplant.nl
De Meester
J
J
Smits
J M
JM
Groenewoud
A F
AF
Bok
A
A
van der Velde
O
O
Doxiadis
I I
II
Persijn
G G
GG
D000241:Adenosine; D000493:Allopurinol; D005060:Europe; D005978:Glutathione; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006982:Hypertonic Solutions; D007328:Insulin; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D015993:Life Tables; D015999:Multivariate Analysis; D009926:Organ Preservation; D019188:Organ Preservation Solutions; D011887:Raffinose; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome
C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose