Increased primary non-function in transplanted deceased-donor kidneys flushed with histidine-tryptophan-ketoglutarate solution.
Histidine-Tryptophan-Ketoglutarate (HTK) solution is increasingly used to flush and preserve organ donor kidneys, with efficacy claimed equivalent to University of Wisconsin (UW) solution. We observed and reported increased graft pancreatitis in pancreata flushed with HTK solution, which prompted this review of transplanting HTK-flushed kidneys. We analyzed outcomes of deceased-donor kidneys flushed with HTK and UW solutions with a minimum of 12 months follow-up, excluding pediatric and multi-organ recipients. We evaluated patient and graft survival and rejection rates, variables that might constitute hazards to graft survival and renal function. Two-year patient survival, rejection, renal function and graft survival were not different, but early graft loss (<6 months) was worse in HTK-flushed kidneys (p < 0.03). A Cox analysis of donor grade, cold ischemic time, panel reactive antibodies (PRA), donor race, first vs. repeat transplant, rejection and flush solution showed that only HTK use predicted early graft loss (p < 0.04; relative risk = 3.24), almost exclusively attributable to primary non-function (HTK, n = 5 (6.30%); UW, n = 1 (0.65%); p = 0.02). Delayed graft function and early graft loss with HTK occurred only in lesser grade kidneys, suggesting it should be used with caution in marginal donors.
Stevens
R B
RB
Department of Surgery, Division of Transplantation, University of Nebraska Medical Center, Omaha, NE, USA. rbstevens@unmc.edu
Skorupa
J Y
JY
Rigley
T H
TH
Yannam
G R
GR
Nielsen
K J
KJ
Schriner
M E
ME
Skorupa
A J
AJ
Murante
A
A
Holdaway
E
E
Wrenshall
L E
LE
D000241:Adenosine; D000328:Adult; D000368:Aged; D000493:Allopurinol; D002102:Cadaver; D051799:Delayed Graft Function / Q000453:epidemiology*; D005260:Female; D005947:Glucose / Q000009:adverse effects; D005978:Glutathione; D006801:Humans; D007328:Insulin; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008353:Mannitol / Q000009:adverse effects; D008875:Middle Aged; D019188:Organ Preservation Solutions / Q000009:adverse effects*; D011189:Potassium Chloride / Q000009:adverse effects; D011343:Procaine / Q000009:adverse effects; D011887:Raffinose; D006435:Renal Dialysis; D014019:Tissue Donors
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