Efficacy of HTK Solution in the Preservation of Donor Hearts

Abstract

Purpose Various preservation solutions for donor hearts are used nationally. We examined transplant outcomes where we used Histidine-tryptophan-ketoglutarate (HTK) solution exclusively since 2004. Methods Retrospective review of UNOS registry comparing our heart transplant outcomes with national outcomes since 2004. Propensity matching (1:3) was performed for donor and recipient age, gender, size, ischemic time , ejection fraction , prior cardiac surgery, heart failure etiology, concomitant kidney/liver transplantation, preop creatinine and preop mechanical support. Survival and postoperative outcomes were examined. We excluded pre-transplant extra-corporeal membrane oxygenation (ECMO), cardiac re-transplantation , heart-lung transplantation , and age less than 18. Results Our heart transplant population had a higher portion of patients with preoperative left ventricular assist device (56.9% vs 32.7%, P 0.05). There was no difference in survival between our institution and the national cohort (figure, P=0.649). Survival at 1, 5 and 10 years at our institution was 92.2%, 81.3%, and 70.8%, and for the UNOS population was 91.5%, 80.2%, and 62.0%. Our institution had a lower incidence of postoperative stroke (1.1% vs 3.1%, P=0.043) and new postoperative dialysis (5.6% vs 9.3%, P=0.028). The Michigan primary graft dysfunction (PGD) rate requiring mechanical support was 4.2%. Postoperative mechanical support utilized for PGD included ECMO (60.0%), right ventricular assist device (33.3%), intra-aortic balloon pump (20.0%), LVAD (13.3%), and biventricular support (13.3%). Conclusion Our exclusive use of HTK solution for donor heart preservation was associated with a low rate of PGD requiring mechanical support. Survival was non-inferior to the national outcomes. HTK is efficacious in preserving donor heart function.