Comparison of histidine-tryptophan-ketoglutarate solution and University of Wisconsin solution in extended criteria liver donors.
Liver, pancreas, and kidney allografts preserved in histidine-tryptophan-ketoglutarate (HTK) and University of Wisconsin (UW) solutions have similar clinical outcomes. This study compares HTK and UW in a large number of standard criteria donor (SCD) and extended criteria donor (ECD) livers at a single center over 5 years. All adult, cadaveric liver and liver-kidney transplants performed between July 1, 2001 and June 30, 2006 were reviewed (n = 698). There were 435 livers (62%) categorized as ECD for severe physiologic stress and 70 (10%) because of old age. Recipient outcomes included perioperative death or graft loss and overall survival. Liver enzymes were analyzed for the first month post-transplant. Biliary complications were assessed through chart review. Overall, 371 donor livers were preserved in HTK (53%), and 327 were preserved in UW (47%). There were no statistically significant differences in any of the primary outcome measures comparing HTK and UW. The HTK group overall had a higher day 1 median aspartate aminotransferase and alanine aminotransferase, but the two groups were similar in function thereafter. HTK was superior to UW in protection against biliary complications. Kaplan-Meier graft survival curves failed to demonstrate a significant difference in SCD or ECD livers. In conclusion, HTK and UW are not clinically distinguishable in this large sample of liver transplants, although HTK may be protective against biliary complications when compared to UW. These findings persisted for both SCD and ECD livers. Given the lower cost per donor for HTK, this preservation solution may be preferable for general use.
Mangus
Richard S
RS
Department of Surgery, Transplantation Section, Indiana University School of Medicine, Indianapolis, IN 46202-5250, USA. rmangus@iupui.edu
Fridell
Jonathon A
JA
Vianna
Rodrigo M
RM
Milgrom
Martin A
MA
Chestovich
Paul
P
Chihara
Ray K
RK
Tector
A Joseph
AJ
D000241:Adenosine / Q000494:pharmacology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000378:metabolism; D000493:Allopurinol / Q000494:pharmacology; D001219:Aspartate Aminotransferases / Q000378:metabolism; D002648:Child; D005260:Female; D005947:Glucose / Q000494:pharmacology; D005978:Glutathione / Q000494:pharmacology; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007328:Insulin / Q000494:pharmacology; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000187:drug effects / Q000201:enzymology / Q000502:physiology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008353:Mannitol / Q000494:pharmacology; D008875:Middle Aged; D019188:Organ Preservation Solutions / Q000494:pharmacology; D018579:Patient Selection; D011189:Potassium Chloride / Q000494:pharmacology; D011343:Procaine / Q000494:pharmacology; D011446:Prospective Studies; D011887:Raffinose / Q000494:pharmacology; D012189:Retrospective Studies; D014019:Tissue Donors
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; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D005978:Glutathione; D005947:Glucose; D000241:Adenosine; D011887:Raffinose