Can we continue blaming on the static preservation solution as the fingle most important cause of DGF or PNF for liver trasplant?

Abstract

Presenter: Gabriel Gondolesi | Hospital Universitario Fundación Favaloro Background: DGF and PNF have shown in different studies the impact they have on early and long term outcomes after liver transplantation. UW has been considered as the Gold Standard preservation solutions until discontinuation. HTK has been the alternative and only available option in different countries. Although controversies have been raised regarding its indications of use and the possible negative impact on graft survival; the preservation solution has been consider by us as just one piece in a very complex procedure, with other variables like DRI, MELD score, logistics, costs (among others) that also have a role as risk factor for graft failure. We aim to analyze the variables involved in a liver transplant procedure during two different eras under the same medical group, but with different preservations solutions (PS), available, in order to evaluate their impact as independent risk factor for graft loss. Methods: A retrospective database analysis of adult (>18 years old) patients receiving a cadaveric donor organ for a primary liver transplant. Diagnoses, MELD score, BMI, time on waiting list (WL), DRI, national, regional or local procurement; preservation solution used total ischemia time (TIT), warm ischemia time (WIT), cold ischemia time (CIT), delay graft function (DGF), primary non function (PNF), LFT’s, biliary complications, incidence of acute and chronic rejection, patient and graft survival, were analyzed comparing the two study periods (UW: 2009-11; HTK: 2016-19). All analyses were performed using IBM SPSS v20.0. Results: A total of 290 liver transplant were performed between 2009-11 and 2016-19; 176 (60.7%) were adult primary liver transplants (102 males (58%) and 74 females (42%)). Diagnoses were: viral infections (n=52, 30%), alcoholic liver disease (n=44, 26%), autoimmune hepatitis (n=30, 18%), metabolic diseases (n=24, 14%), cryptogenic cirrhosis (n=18, 10%) and acute liver failure (n=4, 2%). Table 1 summarizes Donor and Recipient variables. We observed a difference on LFTS`s when we compared the preservation solution used and the primary disease that lead to the liver transplant (Table 1). There were no differences in biliary or venous complications, DGF, PNF or rejection in regards to donor location. Quite the contrary, there was an increased TGO mean value 48 hs post op. and a higher rate of arterial complications (p: 0.0001), and recurrence of the primary disease (p:0.008) in the UW group. Long term patient and graft survival showed no significant difference in favor of the use of HTK (Figure 1), even when MELD score was considerably worse for this group. Conclusion: Liver transplantation is a complex multifactorial procedure. Preservation solution is only “one of the multiple players” involved in it, and its use might depend on availability; but other hospital policies and actions like logistics improvement, reduction of TIT and surgical times should be done in order to maintain expected results, since other variables like DRI and recipient MELD can not be modified.