Histidine-tryptophan-ketoglutarate versus University of Wisconsin solution in living donor liver transplantation: Results of a prospective study

Abstract

The grafts obtained from a living donor hepatectomy are perfused on the back table with either University of Wisconsin solution (UW) or histidine-tryptophan-ketoglutarate solution (HTK). The efficacy and safety of these solutions have been studied in cadaveric liver transplantation, however, there is no study comparing the two solutions in adult-to-adult living donor liver transplantation. In this study, UW and HTK were used in the perfusion of right living donor grafts. The grafts were perfused with a predetermined sequence and volume of one of the solutions. U niversity of Wisconsin solution (UW) and histidine-tryptophan-ketoglutarate solution (HTK) have been used with equal efficacy in the perfusion of abdominal and thoracic cadaveric organs harvested for transplantation. 1,2 Despite their very different compositions, both solutions seem to be equally effective and safe in the long-term preservation of the cadaveric graft. 3 Previous studies comparing the two solutions in cadaveric liver grafts were not randomized, and the results may have been influenced by different factors. Specifically donor age, past medical history, intensive care stay, clinical conditions at the time of the harvest, and ischemic time 4-6 influence the quality of the graft and play a role in the functional recovery of the liver and outcome of the patient.Interestingly, despite the fact that the perfusion of the graft is extremely important in its preservation, there are no standardized guidelines regarding the correct use of the perfusion solutions. Most surgeons perfuse the abdominal organs until the outflow turns clear. A common clinical practice is to infuse 4 to 5 L of UW or 10 to 15 L of HTK in the donor infrarenal aorta for the effective preservation of liver, kidneys, and pancreas. Moreover, some surgeons perfuse the liver graft in situ through both the artery and the portal vein, whereas others perfuse in situ only through the artery; afterward, on the back table, they perfuse ex situ via the portal vein.The first experiences with living donor liver transplantation (LDLT) were done with pediatric patients receiving a left lateral graft. 7,8 Initially these grafts were flushed with UW, but at a late date HTK started to be used with equally good results. 9 Since 1998, adult-toadult LDLT using the right or the left liver has been performed in hundreds of patients. [10][11][12] To date there are no controlled data comparing the efficacy and safety of the two solutions in the perfusion of living donor grafts. Moreover, there are no guidelines regarding the optimal volume of solution that should be infused.Because the method used to perfuse the isolated graft may influence the immediate graft function and eventually the patient outcome we thought that a prospective study comparing UW and HTK was needed. For this purpose, adult LDLT offers a much more controlled setting than cadaveric transplantation. The donors are healthy, the volume of the liver is known, and the quality of the liver is proven by the values of the liver biochemistri...

Organ Preservation: Current Concepts and New Strategies for the Next Decade

“…The advantages of UW solution compared to Marshall solution and Euro-Collins have been proven in large number of experimental and clinical studies [42][43][44]. An introduction of metabolically inert substrates such as lactobionate and raffinose made UW solution universal for multiple organ preservation.…”

Assessment of living donors with respect to pre- and posttransplant psychosocial properties and posttransplant family functioning in pediatric liver transplantation

“…Second, it allows optimal timing of transplantation as an elective procedure and reduces the stress of waiting for a suitable organ. Third, the graft is obtained from a healthy individual with minimal preservation injury (3). However, this procedure exposes the donor, a perfectly healthy individual, to the risk of morbidity and even mortality (4,5).…”

Histidine‐Tryptophan‐Ketoglutarate for Pancreas Allograft Preservation: The Indiana University Experience

“…A recent two-center case series (6) (11,19,20 The first published report of successful pancreas transplantation using HTK flush and preservation was from Indiana University in 2004 (12). Ten pancreas allografts preserved in HTK were compared to the prior 10 allografts stored in UW.…”