Organ preservation with histidine-tryptophan ketogluatarate solution in clinical pancreas transplantation: an update of the indiana university experience.
In May 2003, University of Wisconsin (UW) solution was replaced with Histidine-Tryptophan Ketoglutarate (HTK) solution as the preservation fluid for abdominal organ procurements in our center. Herein we have reported our updated results with HTK in pancreas transplantation. Between May 2003 and October 2006, 152 pancreas transplantations were performed in which 146 used HTK. The procedures were as follows: simultaneous kidney pancreas transplantation (n = 85; 55%), pancreas after kidney transplantation (n = 41; 30%), and solitary pancreas transplantation (n = 20; 15%). Donor and recipient data were collected with primary outcomes as primary nonfunction (PNF), and 30-day and 1-year graft and patient survival. Patient demographics are as follows: age (36 +/- 12 years), gender (males, 89: females, 57), race (white, 135; African American, 11). Mean flush volume was 3.8 +/- 1 L. The mean cold ischemia time was 8 +/- 3 hours. Mean warm ischemia time was 48 +/- 23 minutes. There were no cases of PNF in this cohort. Thirty-day and 1-year patient survival rates were 99% and 95%, respectively. The 30-day and 1-year graft survivals rates were 95% and 93%, respectively. There were 10 grafts lost with 7 vascular complications (6 venous and 1 arterial thrombosis). There were 2 cases of chronic rejection and 1 graft lost to noncompliance. These statistics compare favorably with International Pancreas Transplant Registry reported 1-year survival for pancreas allografts. All other patients were insulin independent by discharge. Serum fasting blood glucose and serial amylase remained comparable at all intervals posttransplantation to those of a historical UW cohort. Within this range of cold ischemia times, HTK appears to provide effective pancreas preservation.
Agarwal
A
A
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Powelson
J A
JA
Goggins
W C
WC
Milgrom
M L
ML
Fridell
J A
JA
D000241:Adenosine; D000293:Adolescent; D000328:Adult; D000493:Allopurinol; D000681:Amylases / Q000097:blood; D002423:Cause of Death; D005260:Female; D005947:Glucose; D005978:Glutathione; D006085:Graft Survival; D006801:Humans; D007328:Insulin; D008297:Male; D008353:Mannitol; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010179:Pancreas; D016035:Pancreas Transplantation / Q000706:statistics & numerical data*; D011189:Potassium Chloride; D011343:Procaine; D011887:Raffinose; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data; D014184:Transplantation, Homologous
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; D000681:Amylases; D005978:Glutathione; D005947:Glucose; D000241:Adenosine; D011887:Raffinose