Does Using HTK Solution for Cold Perfusion of Cadaveric Kidneys Save Money?

Abstract

Since 1987 University of Wisconsin (UW) solution has been the standard solution for cold perfusion and preservation of kidneys for transplant. In 2001, the Food and Drug Administration (USA) approved histidine-tryptophan-ketoglutarate (HTK) for cold perfusion and storage of renal allografts. Data has shown comparable outcomes between UW and HTK for preservation of renal, liver, and pancreatic allografts (1–3). Theoretical advantages for HTK compared to UW solution include: lower viscosity (which might lead to better micro-perfusion of the allograft), lower potassium concentrations, and easier handling properties, although the actual effects on clinical outcomes are unknown. On the other hand, HTK is significantly less expensive than UW solution on a per liter basis. For this reason, HTK has become an attractive alternative to UW solution for some organ procurement organizations. In reported clinical experience with HTK, larger volumes of solution have been used to achieve exsanguination of the recovered organs. The argument is frequently made that these larger volumes negated any significant cost savings associated with the cheaper HTK solution. Gift of Life Michigan switched from UW to HTK solution in December 2003. This decision was based on an impression of clinical equipoise between UW and HTK solutions, with a projected materials cost savings of 47% per donor. We compared the material costs of 77 consecutive kidney-pancreas donor procurements, in which the organs were used for transplant. The perfusion volumes include the aortic flush, the back-table flush of the renal allografts, and the storage volume of the renal grafts. As predicted, significantly larger volumes of fluid were used in the perfusion of the organs with HTK (Table 1). The cost of a liter of UW (UW solution $282, filter $10, and additives $30) was $322/L compared to $148/L for HTK (no additives or filters needed). Costs of UW perfusion were significantly higher than HTK perfusion. The transition from UW to HTK saved $548 (USD) per renal donor. This represents a 43% actual cost reduction, which is similar to the 47% projected reduction. In conclusion, the transition from UW to HTK has resulted in a significant cost savings for Gift of Life Michigan.TABLE 1: UW vs. HTK flush solution for cold perfusion of kidneys for transplantMichael J. Englesbe David Heidt Randall Sung Department of Surgery Division of Transplantation University of Michigan Ann Arbor, MI Richard Pietroski Gift of Life Michigan Ann Arbor, MI