Abstract
Organ preservation plays a crucial role in the outcome following solid organ transplantation. The aim of this study was to perform a retrospective outcome analysis following liver transplantation using histidine tryptophan ketoglutarate (HTK) or the University of Wisconsin (UW) solutions for liver graft preservation. We retrospectively reviewed data on adult patients who were liver-transplanted at Karolinska University Hospital between 2007 and 2015. There was evaluation of donor and recipient characteristics, pre- and post-transplant blood chemistry tests, biliary and vascular complications, graft dysfunction and nonfunction, and patient and graft survivals. A total of 433 patients were included in the analyses, with 230 and 203 patients having received livers preserved with HTK and UW, respectively. Mean follow-up was 45 ± 29 months for the HTK group and 42.4 ± 26 for the UW group. There was no difference between the two groups either in terms of patient and graft survival, or of results of postoperative blood chemistry, or incidence of arterial complications, early allograft dysfunction, or primary graft nonfunction. However, the incidence of biliary stricture was higher in the UW group (22.7%) versus the HTK group (13.5%; p=0.013). Use of UW and HTK preservation solution in liver transplantation has no impact on patient and graft survival. However, use of HTK solution results in a lower incidence of posttransplant biliary stricture.
Highlights
Organ preservation plays an important role in solid organ transplantation [1]
The University of Wisconsin (UW) solution has been the most widely used for liver transplantation for some decades, and it is still regarded as the gold standard for liver preservation ever since 1987 [2,3,4]
A total of 546 orthotopic liver transplantations were performed at the Department of Transplantation Surgery, Karolinska University Hospital in Stockholm. 113 patients were excluded according to the exclusion criteria
Summary
Organ preservation plays an important role in solid organ transplantation [1]. The University of Wisconsin (UW) solution has been the most widely used for liver transplantation for some decades, and it is still regarded as the gold standard for liver preservation ever since 1987 [2,3,4]. It has been shown that hydroxyethyl starch included in UW solution induces red blood cell aggregation, which could promote occlusion and incomplete washout of blood from donor organs during cold perfusion [5, 6]. Potential advantages of using HTK in liver preservation are its lower viscosity, low potassium content, and lower cost [7]. Low viscosity of the preservation solution may provide a better initial flush of the liver, more rapid cooling, and improved washout of blood during organ procurement. The first clinical results of use of HTK in liver transplantation were reported in 1990 [8]. Two large registry studies have shown better graft and patient survival following preservation of the liver graft using UW solutions [11, 12]
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