title: Histidine-Tryptophan-Ketoglutarate (HTK) is associated with reduced graft survival in deceased donor livers, especially those donated after cardiac death.
abstract: Single-center studies have reported that liver allograft survival is not affected by preservation in histidine-tryptophan-ketoglutarate (HTK) versus University of Wisconsin (UW) solution. We analyzed the UNOS database of liver transplants performed from July, 2004, through February, 2008, to determine if preservation with HTK (n = 4755) versus UW (n = 12 673) impacted graft survival. HTK preservation of allografts increased from 16.8% in 2004 to 26.9% in 2008; this was particularly striking among donor after cardiac death (DCD) allografts, rising from 20.7% in 2004 to 40.9% in 2008. After adjusting for donor, recipient and graft factors that affect graft survival, HTK preservation was associated with an increased risk of graft loss (HR 1.14, p = 0.002), especially with DCD allografts (HR 1.44, P = 0.025) and those with cold ischemia time over 8 h (HR 1.16, P = 0.009). Furthermore, HTK preservation was associated with a 1.2-fold higher odds of early (< 30 days) graft loss as compared to UW preservation (OR 1.20, p = 0.012), with a more pronounced effect on allografts with cold ischemia time over 8 h (OR 1.31, p = 0.007), DCD allografts (OR 1.63, p = 0.09) and donors over 70 years (OR 1.67, p = 0.081). These results suggest that the increasing use of HTK for abdominal organ preservation should be reexamined.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Stewart
authors.forename: A M
authors.initials: AM
authors.lastname: Cameron
authors.forename: A L
authors.initials: AL
authors.lastname: Singer
authors.forename: R A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000241:Adenosine / Q000494:pharmacology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000494:pharmacology; D002102:Cadaver; D050377:Cold Ischemia; D015925:Cryopreservation; D003643:Death; D005260:Female; D005947:Glucose / Q000494:pharmacology; D005978:Glutathione / Q000494:pharmacology; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007328:Insulin / Q000494:pharmacology; D016031:Liver Transplantation; D008297:Male; D008353:Mannitol / Q000494:pharmacology; D008875:Middle Aged; D009926:Organ Preservation; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D011189:Potassium Chloride / Q000494:pharmacology; D011343:Procaine / Q000494:pharmacology; D011887:Raffinose / Q000494:pharmacology; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: 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