title: HTK preservative solution is associated with increased biliary complications among patients receiving DCD liver transplants: a single center experience.
abstract: BACKGROUND
  This study compares biliary complication rates associated with use of two different preservative solutions, Histidine-Tryptophan-Ketoglutarate (HTK) and University of Wisconsin (UW), utilized in orthotopic liver transplantation (LT) with donations after cardiac death (DCDs).
  
  
  METHODS
  Between 1997-2010, we retrospectively studied 35 LTs performed utilizing DCD donors, preserved either with HTK (n=17) or UW(n=18). Biliary complications were defined by the presence of anastomotic strictures, non-anastomotic strictures, and/or biliary leak on endoscopic retrograde cholangiopancreatography.
  
  
  RESULTS
  HTK and UW cohorts were similar in terms of demographics as well as pre- and post-operative biochemical profile. Donor age was significantly higher among HTK compared to UW recipients (41.5 ± 11.9 vs. 26.2 ± 8.8 years, p<0.001). The incidence of post-LT biliary complications was higher in the HTK group (76% vs. 39% in UW group, p=0.041). Hepatic arterial thrombosis (HAT) was observed among 3 HTK patients (17.7%) and 1 UW patient (5.6%), p=0.33. No patients underwent retransplantation in UW group, five recipients in HTK group underwent retransplantation (29%), p=0.019; 4 due to biliary complications and 1 due to HAT.
  
  
  CONCLUSIONS
  This single-center study reveals that the use of HTK preservative among DCD donors is associated with an increased risk of biliary complications. Multicenter retrospective studies are suggested to further verify this observation.
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Murat T
authors.initials: MT
authors.lastname: Gulsen
authors.forename: Mohit
authors.initials: M
authors.lastname: Girotra
authors.forename: Guldane
authors.initials: G
authors.lastname: Cengiz-Seval
authors.forename: Jennifer
authors.initials: J
authors.lastname: Price
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Cameron
authors.forename: Ahmet
authors.initials: A
authors.lastname: Gurakar
mesh_terms: D000241:Adenosine; D000328:Adult; D000493:Allopurinol; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology; D001659:Biliary Tract / Q000473:pathology*; D003251:Constriction, Pathologic; D005260:Female; D005947:Glucose / Q000009:adverse effects; D005978:Glutathione; D006499:Hepatic Artery; D006801:Humans; D007328:Insulin; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008353:Mannitol / Q000009:adverse effects; D008875:Middle Aged; D019188:Organ Preservation Solutions / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D011189:Potassium Chloride / Q000009:adverse effects; D011343:Procaine / Q000009:adverse effects; D011887:Raffinose; D012086:Reoperation; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D014019:Tissue Donors
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