Compared Efficacy of Preservation Solutions in Liver Transplantation: A Long-Term Graft Outcome Study From the European Liver Transplant Registry

Abstract

Between 2003 and 2012, 42 869 first liver transplantations performed in Europe with the use of either University of Wisconsin solution (UW; N = 24 562), histidine-tryptophan-ketoglutarate(HTK; N = 8696), Celsior solution (CE; N = 7756) or Institute Georges Lopez preservation solution (IGL-1; N = 1855) preserved grafts. Alternative solutions to the UW were increasingly used during the last decade. Overall, 3-year graft survival was higher with UW, IGL-1 and CE (75%, 75% and 73%, respectively), compared to the HTK (69%) (p < 0.0001). The same trend was observed with a total ischemia time (TIT) >12 h or grafts used for patients with cancer (p < 0.0001). For partial grafts, 3-year graft survival was 89% for IGL-1, 67% for UW, 68% for CE and 64% for HTK (p = 0.009). Multivariate analysis identified HTK as an independent factor of graft loss, with recipient HIV (+), donor age ≥65 years, recipient HCV (+), main disease acute hepatic failure, use of a partial liver graft, recipient age ≥60 years, no identical ABO compatibility, recipient hepatitis B surface antigen (-), TIT ≥ 12 h, male recipient and main disease other than cirrhosis. HTK appears to be an independent risk factor of graft loss. Both UW and IGL-1, and CE to a lesser extent, provides similar results for full size grafts. For partial deceased donor liver grafts, IGL-1 tends to offer the best graft outcome.

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“…The overall 3-year graft survival was higher with UW, IGL-1 and CE (75%, 75% and 73%, respectively), compared to HTK (69%) (P < 0.0001) [67] . The same trend was observed with a total ischemia time > 12 h or for grafts injury and several mechanisms have been proposed to explain this.…”

“…Viscous preservation solutions may negatively impact on efficacy of flushing of the bile ducts capillaries, resulting in residual bile crystallization and obstruction [111][112][113] . Use of less viscous solutions, like HTK, seems to provide better results in reducing the incidence of biliary tract injuries, despite the recent results of the European liver transplant registry data [67,112] . In a large study, a CIT > 10 h was found to be associated with a higher incidence of ITBL and every effort should be made not to exceed this limit [113] .…”

“…A recent study was conducted on 42869 first liver transplants performed in Europe with the use of either University of Wisconsin solution (UW; n = 24562), histidine-tryptophan-ketoglutarate (HTK; n = 8696), Celsior solution (CE; n = 7756) or the Institute Georges Lopez preservation solution (IGL-1; n = 1855) [67] . The overall 3-year graft survival was higher with UW, IGL-1 and CE (75%, 75% and 73%, respectively), compared to HTK (69%) (P < 0.0001) [67] .…”

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“…IGL1 exhibits similar positive outcomes as UW (Codas et al 2009) or even better (Badet et al 2005). Donderó et al (2010) and Adam et al (2015), in a liver transplantation review, summarized the data related to the utility of UW solution and IGL1 solution to resist graft rejection. A slight graft rejection increase with CE solution and a significant reduction with HTK solution was observed.…”

“…Viscosity data refer to a temperature of 4°C. From Petrowsky and Clavien (2014) and Adam et al (2015). to IRI, partly due to protein kinase B (PKB) and eNOS signaling activation, and reduced cytokine release (Zaouali et al 2010a,b).…”