title: Histidine-tryptophan-ketoglutarate (HTK) is associated with reduced graft survival of deceased donor kidney transplants.
abstract: Single-center studies have reported equivalent outcomes of kidney allografts recovered with histidine-tryptophan-ketoglutarate (HTK) or University of Wisconsin (UW) solution. However, these studies were likely underpowered and often unadjusted, and multicenter studies have suggested HTK preservation might increase delayed graft function (DGF) and reduce graft survival of renal allografts. To further inform clinical practice, we analyzed the United Network for Organ Sharing (UNOS) database of deceased donor kidney transplants performed from July 2004 to February 2008 to determine if HTK (n = 5728) versus UW (n = 15 898) preservation impacted DGF or death-censored graft survival. On adjusted analyses, HTK preservation had no effect on DGF (odds ratio [OR] 0.99, p = 0.7) but was associated with an increased risk of death-censored graft loss (hazard ratio [HR] 1.20, p = 0.008). The detrimental effect of HTK was a relatively late one, with a strong association between HTK and subsequent graft loss in those surviving beyond 12 months (HR 1.43, p = 0.007). Interestingly, a much stronger effect was seen in African-American recipients (HR 1.55, p = 0.024) than in Caucasian recipients (HR 1.18, p = 0.5). Given recent studies that also demonstrate that HTK preservation reduces liver and pancreas allograft survival, we suggest that the use of HTK for abdominal organ recovery should be reconsidered.
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: B E
authors.initials: BE
authors.lastname: Lonze
authors.forename: D S
authors.initials: DS
authors.lastname: Warren
authors.forename: N N
authors.initials: NN
authors.lastname: Dagher
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; D000328:Adult; D000493:Allopurinol; D044383:Black People / Q000706:statistics & numerical data; D002102:Cadaver; D002423:Cause of Death; D005006:Ethnicity; D005260:Female; D005947:Glucose / Q000494:pharmacology; D005978:Glutathione; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007328:Insulin; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008353:Mannitol / Q000494:pharmacology; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D011189:Potassium Chloride / Q000494:pharmacology; D011343:Procaine / Q000494:pharmacology; D044469:Racial Groups; D011887:Raffinose; D012189:Retrospective Studies; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods; D014184:Transplantation, Homologous / Q000276:immunology; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
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