Abstracts

HISTADINE-TRYPTOPHAN-KETOGLUTARATE (HTK): AN ALTERNATIVE COLD PERFUSION AND PRESERVATION SOLUTION FOR INTESTINAL AND MULTIVISCERAL ALLOGRAFTS.

G. Bond, G. Mazariegos, R. Sindhi, K. Soltys, G. Costa, K. Abu-Elmagd. Thomas E Starzl Transplant Institute, Pittsburgh, PA.

Purpose: After an initial experience with the solid abdominal organs, intestinal and multivisceral perfusion with HTK commenced in Dec 2002, the first time to our knowledge that it has been used for perfusion of intestinal containing allografts. HTK has low potassium load and decreased viscosity compared to our routine perfusant, University of Wisconsin (UW). Our center previously reported encouraging results with HTK (in liver and kidney), and we now present our expanded experience with intestinal containing allografts.

Methods: Over a 2-year period, a total of 80 intestinal containing allografts were retrieved from multiorgan donors. Of these, 27 (34%) were flushed and preserved with HTK and the remaining 53 (66%) were cooled with the standard UW solution. Demographics including donor age, cause of death, hemodynamic status and other relevant variables were comparable between both groups. There was no significant difference in the type of the visceral allografts and cold ischemia time between both cohorts. The volume used for vascular flushing and central cooling was relatively greater with HTK (70-200 cc/kg) vs. UW (33 - 100 cc/kg). Our early experience suggested a lower volume of HTK was more advantageous, hence reduced volume recently. The harvesting technique was essentially the same in both cohorts.

Results: No allograft in either group was lost to severe preservation injury. Post reperfusion syndrome was observed with more frequency amongst the HTK group. During the early post-operative period, there was no significant difference in the organ specific biochemical indices of preservation injury. Clinically significant pancreatitis was seen more frequently in the HTK cohort, especially in the adult population, sparking the reduction in perfusion volume. However the histopathologic examination of the immediate post-operative full thickness and early post-operative endoscopic mucosal biopsy showed no significant difference in the incidence and degree of preservation injury.

Conclusion: The use of HTK for organ cooling and preservation is safe and should be considered as an alternative to UW. Further reductions in the volume of the perfusate, minimizing the unwanted shearing effect on the endovasculature, could achieve better outcomes with HTK. However HTK has better physiologic properties and can be more easily handled during organ retrieval and the back table procedure.