KIDNEY PRESERVATION WITH IGL-1 SOLUTION: A PRELIMINARY REPORT

Abstract

P40 Aims: Although the University of Wisconsin (UW) solution continues to be the most commonly used preservation solution in multiorgan cadaveric donors, the new solution IGL-1 has been proposed for kidney, liver and pancreas preservation. Its peculiar characteristics are the inversion of K and Na concentration and the substitution with polyethylene glycol for hydroxyethyl starch in UW solution. In the present study we report the first clinical experience started in June 2003 on the outcome of the kidneys preserved in IGL-1 solution in relation to those preserved in UW solution. Methods: We collected the data from 52 cadaveric kidneys preserved in IGL-1 solution and 33 with UW solution. Renal function outcome was evaluated by delayed graft function (DGF) rate, daily urinary output, evolution of serum and urinary creatinine. All the values are expressed as median numbers and statistical studies included a multivariate analysis concerning donor and recipient characteristics and a Mann-Whitney test to assess differences between the groups. Results: The 52 kidneys preserved in IGL-1 solution originated from donors aged from 19 to 70 years (44 yrs), 29 males and 23 females, which were transplanted in recipients aged from 24 to 67 years (48.5 yrs), 32 males and 20 females; cold ischemia time was 16.08 hrs and in 10.4% of the cases it was more than 24 hrs. The 33 kidneys preserved in UW solution originated from donors aged from 16 to 69 years (43.5 yrs), 21 males and 12 females, which were transplanted in recipients aged from 25 to 70 years (48 yrs), 19 males and 14 females; cold ischemia time was 15.83 hrs and in 15.15% of the cases it was more than 24 hrs. The daily evolution of serum creatinine and urinary output were similar between the two groups although a lower Δ-creatinine at day 0-day 1 and a lower creatinine value at day 2 in IGL-1 group. No significant difference in serum creatinine values was shown at 1, 3, 6 months post-transplantation between the two groups. Although there was not a significant difference in Δ urinary creatinine between the two groups, daily urinary creatinine were significantly higher at days 6, 7, 9, 11 and 30 in IGL-1 group. The incidence of DGF, although not statistically significant, was lower in IGL-1 kidneys (7.5%) compared to UW-preserved kidneys (12.1%). Kidney biopsies were obtained before engraftment into the recipients to study the expression of ICAM-1, VCAM-1, specific apoptotic markers and the 6A3-5 gene expression, which is a new transcription factor upregulated by ischemia. Conclusions: The preliminary clinical and histological results of this pilot study seem to confirm our experimental investigations. Although the present results show that IGL-1 in kidney preservation is at least equivalent to UW solution with a prompter graft function and less DGF rate, a larger number of kidneys seem to be necessary to show IGL-1 superiority which has been reported in liver transplantation. A multicentric randomized study will show whether IGL-1 may be the solution of preference in multiorgan cadaveric storage.