INFERIOR OUTCOME OF CADAVERIC KIDNEYS PRESERVED ≥24 HRS IN HISTIDINE-TRYPTOPHAN-KETOGLUTARATE (HTK) SOLUTION

Abstract

360 During recent years, an increasing number of transplant centers within the Eurotransplant organization started using the Histidine-Tryptophan-Ketoglutarate (HTK) solution instead of University of Wisconsin (UW) solution as their preferred cold storage medium for abdominal organ preservation. We report on our single center experience on the outcome of imported kidneys preserved with either HTK or UW in relation to cold ischemia times (CIT) of < or ≥24 hours. Between July 1989 and July 1997, 323 cadaveric kidneys preserved with UW or HTK and imported as a result of an exchange within the Eurotransplant organization were transplanted at our institution. CIT was <24 hrs in 216 kidneys (UW: n=174, HTK: n=42) and ≥24 hrs in 107 kidneys (UW: n=67, HTK: n=41). Renal functional outcome was evaluated by comparing delayed graft function (DGF) rates, daily urinary output, the evolution of serum creatinine(SCr) and creatinine clearance (CrC1) at 1, 3, 5, 7, 14 days and 1, 3, 6, and 12 months postoperatively, and 1 yr graft survival, in relation to the cold storage solution and a CIT of < or ≥24 hrs. Whereas the incidence of DGF did not differ significantly between kidneys preserved for <24 hrs in UW (18.6%) or HTK (26.2%), this rate increased to 50% (HTK) compared to only 23.9% (UW) when kidneys were preserved for ≥24 hrs (P=0.006). Mean SCr and CrCl values were better at 1 and 5 days postoperatively in kidneys preserved for <24 hrs with UW(P<0.05). After 24 hrs of CIT, HTK preserved kidneys showed a more prominently impaired renal function, not only in the immediate postoperative phase, but lasting even significantly different at 1, 3, 6 and 12 months after transplantation (Table,*P<0.05, **P<0.01 UW vs HTK). Graft survival at 1 year was 92.9% in UW vs 87.5% in HTK kidneys preserved for <24 hrs, and 91% vs 77.4% in kidneys stored for ≥24 hrs (P=0.059).From these single center findings we conclude that UW solution remains superior to HTK in kidney preservation, particularly when ischemia times of≥24 hrs can be expected.