UNIVERSITY OF WISCONSIN UW VERSUS HISTIDINETRYPTOPHANKETOGLUTARATE HTK FOR TISSUE PRESERVATION IN LI

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UNIVERSITY OF WISCONSIN (UW) VERSUS
HISTIDINE-TRYPTOPHAN-KETOGLUTARATE (HTK) FOR
TISSUE PRESERVATION IN LIVE DONOR LIVER
TRANSPLANTATION

• Ashok Jain, Ravi Mohanka, Mark Orloff, Peter Abt,
  Randeep Kashyap, Jackie Cullen, Kerrie Lansing,
  Adel Bozorgzadeh
• Department of Surgery, Division of
  Transplantation, University of Rochester Medical
  Centre, Rochester, NY

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Hepatic allograft perfusion and preservation -
Historical

• Euro-Collins
• High K content
• To preserve intra-cellular contents and prevent
  leakage during cold preservation
• Organs were rapidly cooled and preserved in
  solution
• Cold storage allowed preservation up to 6 hours
• Coordination from donor team and recipient team
  was mandatory for graft function

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• Belzer solution University of Wisconsin
• solution (UW)

• Provided the nutrient substrate for high energy
  phosphate bond in Adenosine 5' tri-phosphate
  (ATP) for cellular metabolism
• Buffering agent and
• Anti-oxidant
• This increased the cold preservation up to 16
  hours and beyond
• Converted emergency procedure to a semi-elective
  one
• However, it contained starch, which made it more
  viscous and had high K content

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Contents of Euro- Collins and UW with their
Function
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HTK

• HTK has low K
• Initially used for cardioplegia by Erhard (1996)
• Reports from Germany
• Report from Hong Kong

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Contents of UW and HTK with their Function
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Aim

• To compare hepatic function for first 8 days
  after live donor liver transplantation
• when the graft was perfused
• with UW or HTK solution

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Patients and Methods

• July 2003 to August 2004
• 33 live donor liver transplants
• 9 UW (1 Adult to child 1 left lobe, 7 right
  lobe)
• 24 HTK (all right lobe)
• Daily total bilirubin, AST, ALT, alkaline
  phosphatase, GGTP and INR were examined

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Donor recipient characteristics
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Donor recipient Diagnosis
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Results

• No PNF,
• No Re-transplants for PNF
• 2 HAT in HTK group,
• none in UW
• re-transplant (omitted for analysis)

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Bilirubin mg/dl
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AST
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ALT
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Alkaline Phosphatase
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GGTP
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INR
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Peak Bilirubin
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Peak AST
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Peak ALT
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Peak Alkaline Phosphatase
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Peak GGTP
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Peak INR
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Graft weight ratio gt 1
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Graft weight ratio 1
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Hepatic dysfunction

• Total bilirubin gt 10 at day 8
• INR gt 2 at day 8

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INR gt 2
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Total Bilirubin gt10 mg/dl
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Long term impact

• Patient survival
• 1 dies of recurrent HCC (UW)
• 1 died of seizure disorder (HTK)
• Graft survival
• -2 Retx HAT HTK
• follow-up
• -12 months for all

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Patient Survival
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Graft Survival
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ALT Testa et al study n30
Liver transplantation 8 2003 p 822
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Conclusion

• Both UW and HTK are potent to preserve live donor
  organ without primary non-funciton
• Hepatic dysfunction is two cases of HTK were
  observed with adequate hepatic mass without long
  term consequences
• Higher AST and ALT were observed with HTK in
  immediate post-operative period, which equalized
  by day 8
• More prospective studies in larger population are
  required to determine the long-term impact of
  higher AST, ALT and hepatic dysfunction.

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Thank you for your attention