Comparison of HTK and UW in Abdominal Transplantation

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Comparison of HTK and UW in Abdominal
Transplantation

• Dr. Richard S. Mangus, MD MS
• Indiana University, School of Medicine

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OUTLINE

• Conversion from UW to HTK
• Indiana Organ Procurement Organization
• Indiana University
• Transplant outcomes UW vs HTK
• Kidney transplantation
• Pancreas transplantation
• Liver transplantation
• Intestinal transplantation
• Future research

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Indiana Organ Procurement Organization (IOPO)

• Service area Indiana
• Population 5.1 million
• Hospitals 130
• Transplant centers 7

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Indiana Organ Procurement Organization (IOPO)

• Potential advantages to HTK
• Decreased cost
• Decrease contamination risk
• No mixing
• No filter
• Longer shelf life
• Can store at cool room temperature
• Faster preparation time for coordinator
• - hang it, spike it , infuse it

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Indiana Organ Procurement Organization (IOPO)

• Potential advantages to HTK
• Improved organ flushing
• Lower viscosity
• Faster organ cooling
• No organ flushing before reperfusion
• Lower K load decreases risks of hyperkalemia
  and bradycardia
• Easier to work with on back bench
• ? Improved outcomes

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Indiana Organ Procurement Organization (IOPO)

• Cost analysis HTK vs UW
• UW flush volume / donor 3.5 liters
• UW cost / liter 306.00
• Total cost per donor 1071
• HTK flush volume / donor 3.5 liters
• HTK cost / liter 150.00
• Total cost per donor 525
• Cost savings per donor 546

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Indiana Organ Procurement Organization (IOPO)

• Center cost savings
• Cost savings / donor 546
• Annual cost savings
• for average OPO (200 donors) 109,200

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Indiana University Medical Center

• Abdominal Organ Transplants
• Liver
• Pancreas
• Kidney
• Islets
• Small intestine / Multivisceral

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Indiana University Medical Center

• Abdominal Organ Transplants
• 2007 Rank
• Liver 155 Top 5
• Pancreas 84 1st
• Kidney 255 Top 10
• Small intestine 22 Top 5
• OVERALL ( thoracic) 562 Top 5

www.unos.org, 2007 data report
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Transplant Volume
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Transplant Volume
Conversion to HTK
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• Natural Experiment
• A naturally occurring instance which approaches
  or duplicates a scientific experiment. In
  contrast to laboratory experiments, these events
  aren't created by scientists, but yield
  scientific data. Natural experiments are a common
  research tool in fields where artificial
  experimentation is difficult, such as
  epidemiology.

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Renal Transplantation
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Renal Transplantation
Transplants 1990 to 1992 DGF Need for
dialysis 2 or more times during first 7-days
post-transplant Flush volume HTK 5 6
L UW 1 2 L EC 4 L
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Renal Transplantation
de Boer, et al, Transpl Proc, 1999 31 2065
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Renal Transplantation
de Boer, et al, Transpl Proc, 1999 31 2065
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HTK vs UW KIDNEY Transplantation

• N91 renal transplants HTK 50 UW 41
• No differences in Delayed graft function
• Graft survival
• Patient survival

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Creatinine Clearance Post Transplantation
100
80
60
UW
ml/min
HTK
40
20
0
1
2
3
4
5
6
7
10
14
21
30
time (days)
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(No Transcript)
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HTK vs UW Kidney Transplantation

• N149 renal transplants
• gt 16 hrs HTK 62, UW 87
• No difference patient / graft survival
• HTK lower DGF (24 vs 56, plt0.01)
• gt 24 hrs HTK 31, UW 38
• No difference in patient / graft survival
• HTK lower DGF (16 vs 56, plt0.05)

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PANCREAS TRANSPLANTATION
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Pancreas Transplantation

• N 20 pancreas transplants HTK 10 UW 10
• No differences in Graft survival
• Patient survival
• Serum fasting blood glucose
• Peak serum amylase
• Serial amylase levels

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Pancreas Transplantation
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Pancreas Transplantation

• N 87 pancreas transplants HTK 78 UW 9
• No differences in Graft survival
• Patient survival
• Serum fasting blood glucose
• Peak serum amylase
• Serial amylase levels

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Pancreas Transplantation
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Pancreas Transplantation
Primary preservation solution HTK, 2003 to 2007
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Pancreas Islet Transplantation
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Pancreas Islet Transplantation
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LIVER TRANSPLANTATION
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Liver Transplantation

• N378 liver transplants HTK 174 UW 204

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Liver Transplantation ECD

N698 liver transplants HTK 371 UW
327 Groups Standard 209 (30) ECD (old
age) 70 (10) ECD (physiologic stress) 435
(62)
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Liver Transplantation ECD
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Liver Transplantation ECD

N698 HTK 371 UW 327
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Liver Transplantation ECD
Standard donors, n209
Extended criteria donors, n489
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Liver Transplantation ECD
Donor 60 years, n70
Donor lt 60 years, n628
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Liver Transplantation ECD
No physiologic stress, n263
Physiologic ECD, n435
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Liver Transplantation ECD
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Liver Transplantation

• Biliary complications

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Liver Transplantation

• Biliary complications

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Liver Transplantation
Donation after cardiac death, n43 HTK 35 UW
7
41
Liver Transplantation Recent

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Intestinal / Multivisceral Transplantation
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Intestinal Transplantation

• Comparison of HTK and UW in Intestinal and
  Multivisceral Transplantation
• - Mangus, et al. Transplantation, 2008 In Press

N57 intestinal transplants HTK 35 UW 22
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Intestinal Transplantation
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Intestinal Transplantation
N57 intestinal transplants HTK 35 UW 22
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Intestinal Transplantation

• No difference between HTK and UW in graft and
  patient survival at 30- and 90-days, and 1-year
  post-transplant
• No differences noted in
• Initial function
• Appearance on early magnification endoscopy
• Rejection episodes
• Transplant pancreatitis

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CONCLUSIONS

• Cost savings associated with HTK use
• No demonstrated difference in outcomes for
  kidney
• pancreas
• pancreatic islets
• liver
• intestine
• Possible decrease in biliary complications for
  HTK in liver transplantation
• Possible long-term improvement in survival with
  HTK in liver transplantation

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HTK vs UW FUTURE RESEARCH

• HTK vs UW
• Prolonged cold ischemia time
• Transplant pancreatitis
• DCD allografts
• Biliary complications / Flush of microcirculation
• Multicenter data large volume data analysis