Comparison of University of Wisconsin and Histidine-Tryptophan-Ketoglutarate Solutions in Donation After Cardiac Death Liver Transplantation.

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Aim There is no consensus on the optimal preservation solution in DCD liver transplantation (LTx), especially regarding the risk of ischemic-type biliary lesions (ITBL). Both UW and HTK solutions have been successfully used. We reviewed our experience with both preservation solutions in DCD LTx. Methods We performed 35 adult primary DCD LTx between 1/2008-10/2013. UW was used in 24(69%) grafts (group A) and HTK in 11(31%, group B), depending on the procuring OPO protocol. Donor age, BMI, ethnicity, warm ischemia time and macrosteatosis (gr. A biopsies n=14, gr. B n=6) were comparable between the 2 groups. We compared UW and HTK in terms of AST/ALT decline within the first week, incidence and timing of biliary complications requiring ERCP and patient and graft survival. Results Median follow-up was 619 days (range 65-1596). Overall, 11(29%) patients developed ITBL at a median of 130 days after LTx (range 48-482): 7(29%) in gr. A and 4(36%) in gr. B (p=0.71). Time interval from LTx to ERCP was comparable between gr. A (median 141±167 days) and gr. B (median 117.5±117.5 days; p=0.78).Figure: No Caption available.The AST/ALT decline within the first week was comparable in the two groups (POD1 median AST/ALT=1032/866 vs. 1166/705 [p=0.18] and POD7 47/170 vs. 55/219 [p=0.84]). Three-year patient survival was 73% and 78% (p=0.71) and graft survival was 74% and 78% (p=0.72), respectively.Figure: No Caption available.Conclusion In our experience of DCD LTx, UW and HTK are comparable in terms of early post-transplant recovery from ischemic injury as reflected by the decline of transaminases, incidence and timing of biliary stricture requiring ERCP and patient and graft survival. Larger series are warranted to further determine the impact of different preservation solutions on the outcome of DCD LTx.

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