Type of Preservation Solution, UW or HTK, Has an Impact on the Incidence of Biliary Stricture following Liver Transplantation: A Retrospective Study

Abstract

Organ preservation plays a crucial role in the outcome following solid organ transplantation. The aim of this study was to perform a retrospective outcome analysis following liver transplantation using histidine tryptophan ketoglutarate (HTK) or the University of Wisconsin (UW) solutions for liver graft preservation. We retrospectively reviewed data on adult patients who were liver-transplanted at Karolinska University Hospital between 2007 and 2015. There was evaluation of donor and recipient characteristics, pre- and post-transplant blood chemistry tests, biliary and vascular complications, graft dysfunction and nonfunction, and patient and graft survivals. A total of 433 patients were included in the analyses, with 230 and 203 patients having received livers preserved with HTK and UW, respectively. Mean follow-up was 45 ± 29 months for the HTK group and 42.4 ± 26 for the UW group. There was no difference between the two groups either in terms of patient and graft survival, or of results of postoperative blood chemistry, or incidence of arterial complications, early allograft dysfunction, or primary graft nonfunction. However, the incidence of biliary stricture was higher in the UW group (22.7%) versus the HTK group (13.5%; p=0.013). Use of UW and HTK preservation solution in liver transplantation has no impact on patient and graft survival. However, use of HTK solution results in a lower incidence of posttransplant biliary stricture.

Is a Preservation Solution for Living Donor Liver Transplantation Needed? Adding a New Chapter in LDLT!

“…Other studies have reported controversies about the role of preservative solutions in biliary complications. Studies by Karakoyun et al 26 and Heidenhain et al 27 reported an increased risk of biliary complications using the UW solution as compared with the HTK solution. However, other studies showed heterogeneous results and found that HTK solution was associated with an increased risk of biliary complications.…”

Melatonin in preservation solutions prevents ischemic injury in rat kidneys

“…HTK solution has been successfully used in organ preservation since the 1980s. The main advantage of the HTK solution is the lower risk of biliary complications in liver transplantation [ 42 ]. Histidine is a very potent buffer and in comparison to UW, HTK solution has very low viscosity and showed the same efficacy and safety profiles as UW in randomized prospective trials [ 18 ].…”

The effect of organ preservation solutions on short‐term outcomes after liver transplantation: a single‐center retrospective study

“…In contrast, preservation solutions with low viscosity have been postulated to improve liver washout during procurement and to better protect from IRI and its complications, such as graft dysfunction and post‐transplant cholangiopathy in particular [24,25]. HTK is characterized by low viscosity; nevertheless, its hypothesized beneficial effect on EAD was disproved in an earlier study of the UNOS database [26] and in a recent single‐center study [27], and the observations from our analyses point toward the same direction. IGL‐1 is also characterized by low viscosity, [28] and preliminary pre‐ and clinical studies suggested that IGL‐1 may be particularly suited for the flush out of the microcirculation, thereby reducing the occurrence of post‐transplant cholangiopathies [11,29–31].…”