Comparison of Histidine-Tryptophan-Ketoglutarate and University of Wisconsin Preservation in Renal Transplantation

Abstract

Histidine-tryptophan-ketoglutarate (HTK) is replacingUniversity of Wisconsin (UW) solution as the preservation fluid for renal allografts in many centers, but recent large-scale data to support this transition are lacking. We conducted a retrospective analysis of patient and graft outcomes after renal transplantation at our center, comparing 475 consecutive living donor and 317 deceased donor transplants since the adoption of HTK with equal numbers of grafts preserved using UW solution. Data collected included donor and recipient age, race, sex, comorbidities and graft ischemia time. Graft and patient survival, as well as the incidence of delayed graft function (DGF), were studied by Kaplan-Meier and Cox regression analysis. No significant difference was seen in either patient or graft survival. Deceased donor kidneys in the HTK group had a higher incidence of DGF than the UW cohort, whereas this trend was reversed in the case of living donor organs. In multivariate analysis, HTK was associated with a significant risk reduction on the incidence of DGF. Prolonged preservation with HTK compared to UW was not associated with excess risk to the graft or patient. In summary, HTK demonstrated efficacy similar to UW in terms of patient and graft survival.

Use of a New Modified HTK Solution for Machine Preservation of Marginal Liver Grafts

“…The introduction of the University of Wisconsin solution in 1988 [1] represented a major breakthrough, allowing static cold storage of kidneys and extrarenal organs for more than 12 h. A variety of other preservation solutions have been proposed since then (reviewed in [2]), including the successful introduction of Bretschneider's histidine-tryptophanketoglutarate (HTK) solution, originally developed for cardioplegia, in preservation of liver and kidneys [3]. Nowadays HTK solution is an established standard in kidney and liver preservation, equivalent to the University of Wisconsin (UW) solution [4][5][6]. Given the challenges to contemporary clinical practice, donor criteria are more and more extended up to and including pre-damaged organs from non-heart beating donors [7].…”

Interferon-Based Anti-Viral Therapy for Hepatitis C Virus Infection after Renal Transplantation: An Updated Meta-Analysis

“…An additional 391 reports were excluded on the basis of title, resulting in 113 eligible trials. Of these, 39 reports were review articles; eight were case reports [19]–[23], [29], [30], [39]; one was an interim report [40]; 12 were conference abstracts [24]–[28], [31], [32], [41]–[45]; 2 included HCV co-infected with HBV [46], [47]; five were combined liver kidney transplantation [48]–[52] and one included patients on maintenance dialysis [53] at the same time, and seven articles contained confounding factors [54]–[60]. After these exclusions, 12 reports met our eligibility criteria and were included in the meta-analysis [61]–[72].…”

“…IFN/RIB/Amantadine/PEG) [19]–[28]. However, there are some case reports that describe successful treatment of chronic HCV infection in RT recipients using combination therapies (i.e.…”

Cold Ischaemic Injury in Kidney Transplantation

“…It also contains 2 amino acids, tryptophan, to stabilize cellular membranes and prevent oxidant damage and ketoglutararate, a substrate to support anaerobic metabolism. Recent concerns have been raised regarding its use for ECD and DCD kidneys or for kidneys with prolonged storage times [73]. Some clinical studies have associated its use with the increased risk of PNF and early graft loss [74].…”