Histidine-tryptophan-ketoglutarate solution vs. University of Wisconsin solution for liver transplantation: a systematic review.
University of Wisconsin (UW) solution has been recognized as the gold standard in liver preservation, but its limitations are becoming obvious, such as risk of biliary complications and its high cost. Alternatively, the effects of histidine-tryptophan-ketoglutarate (HTK), such as improved biliary protection and low cost, have been observed. This systematic review is conducted to compare the efficacy and safety of these 2 solutions. Databases from 1966 to June 2006 were searched. Randomized clinical trials (RCTs) and cohort studies comparing HTK and UW solutions for liver transplantation were included. Ten articles including 11 comparisons (1,200 patients) met the inclusion criteria, containing 2 RCTs and 9 cohort studies. No marked differences existed between the 2 groups in patient and graft survival rates, acute rejection, primary nonfunction, primary dysfunction, delayed graft function, and ALT and AST levels after transplantation. The only positive result was observed in the bile production after deceased donor liver transplantation (DDLT), which was statistically significantly higher in HTK group than that of UW group (95% confidence interval, 18.65-57.47; P=0.0001). Although the difference in biliary complications between the 2 groups did not reach statistical significance, HTK was thought to be more effective for biliary tract flush and prevention of biliary complications in some studies. There was no statistically significant difference of effects (except bile production) between HTK and UW. But trends were documented in some studies for the superiority of HTK in biliary tract flush, prevention of biliary complications, and cost saving. Adequately powered RCTs with longer follow-up periods are required to evaluate the long-term effect of these 2 solutions.
Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, West China Hospital, Sichuan University, PR China. feng31@sohu.com
Li
L
Feng
Na
N
Zhao
Xun
X
Yao
Xin
X
Sun
Liang
L
Du
Xiang
X
Diao
Shengfu
S
Li
Youping
Y
Li
D000241:Adenosine / Q000737:chemistry / Q000494:pharmacology; D000493:Allopurinol / Q000737:chemistry / Q000494:pharmacology; D000818:Animals; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D005947:Glucose / Q000737:chemistry / Q000494:pharmacology; D005978:Glutathione / Q000737:chemistry / Q000494:pharmacology; D006801:Humans; D007328:Insulin / Q000737:chemistry / Q000494:pharmacology; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D008353:Mannitol / Q000737:chemistry / Q000494:pharmacology; D009926:Organ Preservation / Q000009:adverse effects / Q000379:methods*; D019188:Organ Preservation Solutions / Q000737:chemistry* / Q000494:pharmacology; D010477:Perfusion; D011189:Potassium Chloride / Q000737:chemistry / Q000494:pharmacology; D011343:Procaine / Q000737:chemistry / Q000494:pharmacology; D011887:Raffinose / Q000737:chemistry / Q000494:pharmacology; D016896:Treatment Outcome
C039984:Bretschneider cardioplegic solution; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D008353:Mannitol; D011343:Procaine; D000493:Allopurinol; D011189:Potassium Chloride; D005978:Glutathione; D005947:Glucose; D000241:Adenosine; D011887:Raffinose