Comparison of histidine-tryptophan-ketoglutarate solution and University of Wisconsin solution in intestinal and multivisceral transplantation.
BACKGROUND
Previous studies have failed to demonstrate a clinical difference between histidine-tryptophan-ketoglutarate (HTK) and University of Wisconsin (UW) preservation solutions in clinical transplant outcomes for liver, pancreas, and kidney transplantation. This study compares HTK and UW in bowel transplantation with primary outcomes being graft and patient survival, early graft function, and episodes of rejection.


METHODS
Data were extracted using a retrospective chart and medical record review of all bowel transplants between 2003 and 2007, and included both pediatric and adult grafts. Transplanted organs included isolated small bowel, modified multivisceral (bowel, pancreas, and stomach) and multivisceral (bowel, pancreas, stomach, and liver). Immunosuppression included induction with a steroid taper and antithymocyte globulin and anti-CD20 monoclonal antibody (rituximab), followed by maintenance with prograf monotherapy. Bowel surveillance was performed with twice weekly zoom endoscopy and biopsy.


RESULTS
There were 54 patients transplanted with 57 grafts, 22 preserved in UW, and 37 in HTK. No differences were noted between the two solutions in initial graft function, appearance of bowel on initial endoscopy, and number of rejection episodes. There were no episodes of pancreatitis in the 44 multivisceral grafts which included a transplant pancreas (14 UW and 30 HTK). Kaplan-Meier survival analysis did not demonstrate a significant difference in graft or patient survival at 30- or 90-days posttransplant.


CONCLUSIONS
Intestinal grafts preserved in UW and HTK demonstrate no difference in graft and patient survival at 30- and 90-days posttransplant. There were no differences noted in initial function, endoscopic appearance, rejection episodes, or transplant pancreatitis.
Mangus
Richard S
RS
Department of Surgery, Transplantation Section, Indiana University School of Medicine, Indianapolis, IN 46202-5250, USA. rmangus@iupui.edu
Tector
A Joe
AJ
Fridell
Jonathan A
JA
Kazimi
Marwan
M
Hollinger
Edward
E
Vianna
Rodrigo M
RM
D000241:Adenosine / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D001706:Biopsy; D004724:Endoscopy; D005947:Glucose / Q000627:therapeutic use; D005978:Glutathione / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D019188:Organ Preservation Solutions / Q000627:therapeutic use*; D016377:Organ Transplantation / Q000379:methods; D011189:Potassium Chloride / Q000627:therapeutic use; D011343:Procaine / Q000627:therapeutic use; D011887:Raffinose / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; C039984:Bretschneider cardioplegic solution; D007166:Immunosuppressive Agents; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D008353:Mannitol; D000069283:Rituximab; D011343:Procaine; D000493:Allopurinol; D011189:Potassium Chloride; D005978:Glutathione; D005947:Glucose; D000241:Adenosine; D011887:Raffinose