A propensity score matched analysis of liver transplantation outcomes in the setting of preservation solution shortage

The recent shortage of the University of Wisconsin (UW) solution prompted increased utilization of histidine-tryptophan-ketoglutarate (HTK) solution for liver graft preservation. This contemporary study analyzed deceased donor liver transplant outcomes following preservation with HTK vs UW. Patients...

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Bibliographic Details
Published in:American journal of transplantation 2024-04, Vol.24 (4), p.619-630
Main Authors: Preston, William A., Pace, Devon J., Altshuler, Peter J., Yi, Misung, Kittle, Haley D., Vincent, Sage A., Andreoni, Kenneth A., Frank, Adam M., Glorioso, Jaime M., Ramirez, Carlo G., Maley, Warren R., Shah, Ashesh P., Bodzin, Adam S.
Format: Article
Language:English
Subjects:
Allopurinol
Glucose
Glutathione
histidine-tryptophan-ketoglutarate (HTK)
Humans
Insulin
Liver Transplantation
Living Donors
Mannitol
Organ Preservation Solutions
Potassium Chloride
preservation solution
primary nonfunction (PNF)
Procaine
Propensity Score
Retrospective Studies
survival
University of Wisconsin (UW)
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Summary:The recent shortage of the University of Wisconsin (UW) solution prompted increased utilization of histidine-tryptophan-ketoglutarate (HTK) solution for liver graft preservation. This contemporary study analyzed deceased donor liver transplant outcomes following preservation with HTK vs UW. Patients receiving deceased donor liver transplantations between January 1, 2019, and June 30, 2022, were retrospectively identified utilizing the Organ Procurement and Transplant Network database, stratified by preservation with HTK vs UW, and a propensity score matching analysis was performed. Outcomes assessed included rates of primary nonfunction, graft survival, and patient survival. There were 4447 patients in each cohort. Primary nonfunction occurred in 60 (1.35%) patients in the HTK group vs 25 (0.54%) in the UW group (P < .001). HTK was associated with lower 90-day graft survival (94.39% vs 96.09%; P < .001) and 90-day patient survival (95.97% vs 97.38%; P = .001). Unmatched donation after cardiac death-specific analysis of HTK vs UW demonstrated respective rates of primary nonfunction of 1.63% vs 0.82% (P = .20), 90-day graft survival of 92.50% vs 95.29% (P = .069), and 90-day patient survival of 93.90% vs 96.35% (P = .077). These results suggest that HTK may not be an equivalent preservation solution for deceased donor liver transplantation. [Display omitted]
ISSN:1600-6135
1600-6143
DOI:10.1016/j.ajt.2023.10.028