Liver grafts from ECD can be used to dramatically reduce wait list time with outcomes comparable to those for SD without resorting to living donor liver transplantation.

See Editorial on Page 196University of Wisconsin solution (UW) is the standard preservation solution in cadaveric liver, kidney, pancreas, and small bowel transplantation. The effectiveness of this solution has been demonstrated and has revolutionized the field of transplant surgery. Several competing preservation solutions have been developed, and studies comparing these solutions to UW are ongoing. Histidine-tryptophan-ketoglutarate preservation solution (HTK) was developed in the 1970s as a cardioplegia solution and has recently been used routinely by many centers in kidney, liver, and pancreas preservation.1-8 The composition of these solutions has been described in detail previously. UW was developed by Folkert O. Belzer and is based upon three philosophies: 1) osmotic concentration maintained by metabolically inert substrates, 2) additional administration of the colloid carrier hydroxyethylstarch (HES), and 3) addition of oxygen radical scavengers. UW provides organ tolerance to long cold Abbreviations: HTK, Histidine-tryptophan-ketoglutarate solution; UW, University of Wisconsin solution. Address reprint requests to Dr.

In the past decade, the annual number of pancreas transplantations performed in the United States has steadily declined. From 2004 to 2011, the overall number of simultaneous pancreas-kidney (SPK) transplantations in the United States declined by 10%, whereas the decreases in pancreas after kidney (PAK) and pancreas transplant alone (PTA) procedures were 55% and 34%, respectively. Paradoxically, this has occurred in the setting of improvements in graft and patient survival outcomes and transplanting higher-risk patients. Only 11 centers in the United States currently perform ≥20 pancreas transplantations per year, and most centers perform <5 pancreas transplantations annually; many do not perform PAKs or PTAs. This national trend in decreasing numbers of pancreas transplantations is related to a number of factors including lack of a primary referral source, improvements in diabetes care and management, changing donor and recipient considerations, inadequate training opportunities, and increasing risk aversion because of regulatory scrutiny. A national initiative is needed to "reinvigorate" SPK and PAK procedures as preferred transplantation options for appropriately selected uremic patients taking insulin regardless of C-peptide levels or "type" of diabetes. Moreover, many patients may benefit from PTAs because all categories of pancreas transplantation are not only life enhancing but also life extending procedures.

MVT can be considered as an option for the treatment of patients with diffuse PMT. MVT is the only procedure that completely reverses portal hypertension and addresses the primary disease while achieving superior survival results in comparison to the alternative options.