Greater hemodynamic instability with histidine-tryptophan-ketoglutarate solution than University of Wisconsin solution during the reperfusion period in living donor liver transplantation.
OBJECTIVE
University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the 2 most commonly used liver preservation solutions. The aim of this study was to compare cardiovascular stability, acid-base status, and potassium concentrations between patients who received grafts preserved in either UW or HTK solution in orthotopic liver transplantation (OLT).


METHODS
In this retrospective study, 87 patients who underwent living donor OLT were divided into 2 groups: UW (n = 28) and HTK (n = 59). Group HTK was subdivided into group NF-HTK (n = 31; nonflushed before reperfusion) and group F-HTK (n = 28; flushed before reperfusion). We determined mean arterial pressure (MAP) and heart rate every minute for 5 minutes after reperfusion and the maximum change in these values and incidence of postreperfusion syndrome (PRS). Body temperature, cardiovascular and acid-base parameters, as well as potassium concentrations were compared at 5 minutes before and 5 and 30 minutes after reperfusion.


RESULTS
The maximum decreases in MAP within 5 minutes after reperfusion were significantly greater in both the NF-HTK and the F-HTK groups. The rate of PRS was significantly greater in the NF-HTK compared with the UW group. Flushing with HTK solution decreased the rate of PRS; there was no significant difference between the F-HTK and UW groups. All serial changes in body temperature, cardiovascular and acid-base parameters, as well as potassium concentrations were similar among the 3 groups.


CONCLUSIONS
The incidence of PRS was greater using HTK compared with UW solution during the reperfusion period. Therefore, careful hemodynamic management is advised when using HTK solution.
Ko
J S
JS
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kim
G S
GS
Gwak
M S
MS
Yang
M
M
Kim
H K
HK
Shin
B S
BS
Kim
J K
JK
Lee
S K
SK
D000136:Acid-Base Equilibrium / Q000187:drug effects / Q000502:physiology; D000241:Adenosine; D000328:Adult; D000493:Allopurinol; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D005947:Glucose / Q000009:adverse effects; D005978:Glutathione; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007328:Insulin; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000502:physiology; D019520:Living Donors; D008297:Male; D008353:Mannitol / Q000009:adverse effects; D008875:Middle Aged; D019188:Organ Preservation Solutions / Q000009:adverse effects*; D011169:Portal Vein; D011188:Potassium / Q000097:blood; D011189:Potassium Chloride / Q000009:adverse effects; D011343:Procaine / Q000009:adverse effects; D011887:Raffinose; D015427:Reperfusion Injury / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies
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; D011188:Potassium