Early Pancreas Transplant Outcomes with Histidine-Tryptophan-Ketoglutarate Preservation: A Multicenter Study

Abstract

Little is known about the use of histidine-tryptophan-ketoglutarate (HTK) preservation solution for pancreas preservation. We compared early pancreas graft outcomes at four pancreas transplant programs within the state of Michigan in 2002 and 2003 (University of Wisconsin [UW] era) with those in 2004 (HTK era). The primary endpoint was early graft loss. The UW group (n=41) and the HTK group (n=36) had similar outcomes with respect to: technical graft loss (9.8% vs. 8.3%, P=NS), 90-day graft function (90.2% vs. 86.1%, P=NS), and rate of pancreatic leak/abscess (12.2% vs. 11.1%, P=NS). There were also no significant differences in postoperative amylase and lipase levels between the two groups. The HTK group did have significantly more acute rejection within the first 180 days (25.0% vs. 9.8%, P<0.05). HTK is a suitable substitute for UW in the preservation of pancreas allografts.

Histidine-Tryptophan-Ketoglutarate (HTK) Is Associated with Reduced Graft Survival in Pancreas Transplantation

“…Furthermore, A closer examination of the allograft survival curves in Figure 2 suggested a dominant early effect of preservation solution; this was consistent with a recent single-center report (2). To differentiate between early and late effects in the national population, we developed a multivariate Reduced Pancreas Graft Survival with HTK these results are the short CIT (<12 h) in this (4) and prior case series (2,(5)(6)(7)(8)(9) (13)(14)(15)(16)(17). These gross findings also correlated with histological evidence of increased interstitial edema and cellular swelling (15)(16)(17).…”

Using HTK for Prolonged Pancreas Preservation Prior to Human Islet Isolation

“…The reasons for replacement of UWS by HTK can be partially related to economic considerations [25]. In agreement with numerous studies evaluating the effect of HTK on pancreas [2,4,6,7,26], kidney [27], and liver transplantation [3], the only islet studies that have been performed so far did not find any significant difference between HTK and UWS with regard to isolation and post-transplant outcome [12,13,28]. In contrast, several multicenter studies provided opposite results for pancreas [8], kidney [10,24], and liver transplantation [11].…”

“…Furthermore, the lower viscosity of HTK seems to facilitate enhanced clearance of organs from blood compared with UWS [4]. In pancreas transplantation, the majority of the current reports did not reveal any significant differences between UWS and HTK with respect to graft survival [2,[5][6][7]. Nevertheless, two studies analyzing more than 4000 pancreas transplants have raised concerns about the efficiency of HTK, particularly if utilized for prolonged cold ischemia time (CIT) [8,9].…”

Increased Pancreatitis in Allografts Flushed with Histidine-Tryptophan-Ketoglutarate Solution: A Cautionary Tale

“…We reviewed our experience with HTKflushed pancreata to determine whether there was a basis for suspecting a causal relationship. (6)(7)(8).…”