Histidine-tryptophan-ketoglutarate solution vs. University of Wisconsin solution for liver transplantation: A systematic review

Abstract

University of Wisconsin (UW) solution has been recognized as the gold standard in liver preservation, but its limitations are becoming obvious, such as risk of biliary complications and its high cost. Alternatively, the effects of histidine-tryptophanketoglutarate (HTK), such as improved biliary protection and low cost, have been observed. This systematic review is conducted to compare the efficacy and safety of these 2 solutions. Databases from 1966 to June 2006 were searched. Randomized clinical trials (RCTs) and cohort studies comparing HTK and UW solutions for liver transplantation were included. Ten articles including 11 comparisons (1,200 patients) met the inclusion criteria, containing 2 RCTs and 9 cohort studies. No marked differences existed between the 2 groups in patient and graft survival rates, acute rejection, primary nonfunction, primary dysfunction, delayed graft function, and ALT and AST levels after transplantation. The only positive result was observed in the bile production after deceased donor liver transplantation (DDLT), which was statistically significantly higher in HTK group than that of UW group (95% confidence interval, 18.65-57.47; P ϭ 0.0001). Although the difference in biliary complications between the 2 groups did not reach statistical significance, HTK was thought to be more effective for biliary tract flush and prevention of biliary complications in some studies. There was no statistically significant difference of effects (except bile production) between HTK and UW. But trends were documented in some studies for the superiority of HTK in biliary tract flush, prevention of biliary complications, and cost saving. Adequately powered RCTs with longer follow-up periods are required to evaluate the long-term effect of these 2 solutions.

Strategies to optimize the use of marginal donors in liver transplantation

“…Simultaneous graft revascularization seems to be associated with a lower incidence of ITBL than sequential revascularization [109,110] . 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] .…”

“…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] .…”

Ischemia-Reperfusion Injury Associated with Liver Transplantation in 2011: Past and Future

“…The reduced viscosity of HTK as compared to UW has been hypothesized to be protective against the development of biliary complications. However, the impact of HTK versus UW preservation on biliary complications remains unclear, as some centers report equivalent, increased or reduced rates of biliary complication with HTK preservation of deceased donor liver allografts (Feng et al, 2007;Steawart et al, 2009). …”

Optimization of Cooling Protocols for Hearts Destined for Transplantation

“…In other research, both solutions have been tested and compared for different organs [35,36,37]. Reichenspurner et al [38] compared UW versus HTK solution for myocardial protection in heart transplantation.…”