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Organ preservation and utilization

Monday September 12, 2022 - 11:35 to 13:05

Room: C3

212.9 Preservation solutions for static cold storage in DCD and DBD liver transplantation in the United States

Diego Di Sabato, United States

Assistant Professor
Transplant Institute UCM
University of Chicago

Abstract

Preservation solutions for static cold storage in DCD and DBD liver transplantation in the United States

Diego Di Sabato1, Thomas G. Cotter2, Matthew A. Odenwald1, Angelica Perez-Gutierrez1, Jayant Kumar1, Michael Charlton 1, John Fung1.

1Transplant Institute , University of Chicago, Chicago, IL, United States; 2Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, United States

Static cold preservation remains the cornerstone for storing donor livers following procurement, however, the choice between University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions remains controversial.  Recent ILTS guidelines have recommended avoiding HTK solution for donation after circulatory death (DCD) grafts based on older reports.  We studied the latest US adult graft outcomes in 3 recent eras (2006-2010; 2011-2015; 2016-2020) comparing HTK and UW solutions among 5,956 DCD LTs: 3,873 (65.0%) used UW and 1,944 (32.7%) used HTK; and 82,679 donation after brain death (DBD) liver transplantations (LTs): 63,511 (76.8%) used UW and 15,855 (19.2%) used HTK. The HTK group had higher 1- and 5-year graft survival rates of 89.7% and 74.3%, respectively, compared with 85.9% and 70.8% in the UW group in the 2016-2020 era (p=0.005).  This difference remained when adjusted for important potential confounders (HR 0.78, 95% CI: 0.60, 0.99). There were no differences between groups among DCD LTs in the earlier eras, and among DBD LTs in all eras (all p-values>0.05).  The latest US data suggests that HTK is at least non-inferior to UW for preserving DCD livers.  These data support HTK use in DCD LT and contradict ILTS guidance.

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