Abstracts

IS HISTADINE-TRYPOPHAN-KETOGLUTARATE (HTK) A BETTER COLD PRESERVATIVE SOLUTION FOR INTESTINAL AND MULTIVISCERAL ALLOGRAFTS

Geoffrey Bond, Shushma Aggarwal, Bonita Schuster, Kyle Soltys, Rakesh Sindhi, Guilherme Costa, Jorge Reyes, George Mazariegos, Kareem Abu-Elmagd. University of Pittsburgh Medical Center, Thomas E Starzl Transplantation Institute, Pittsburgh, PA.

Purpose:Recent data showed that HTK is as effective as UW for vascular flushing and preservation of abdominal solid organs. Accordingly, a nonrandomised controlled study was initiated to assess safety and efficacy of HTK among visceral allografts with intestine alone or en-bloc with other organs including liver and pancreas.

Methods: In 131 consecutive allografts, HTK was used for 52 and remaining 79 were retrieved from different UNOS regions that did not permit use of HTK and UW was utilized. The donor characteristics, type of allograft and cold ischemic time were similar. The volume used for central vascular cooling was 100-200 cc/kg(HTK) and 33-100 cc/kg(UW). The latest HTK allografts received less volume for vascular flushing. None of the donors were pretreated with antilymphocyte preparations and most allografts were retrieved by the same surgeon adopting the same donor surgical techniques. Biochemical and histologic criteria diagnostic of preservation injury were closely monitored for each contained organ.

Results: The intraoperative hemodynamic and metabolic changes suggestive of post reperfusion syndrome were significantly(p<0.05) higher in HTK cohort. There was no significant differences between both groups comparing biochemical and histopathologic indicators of preservation injury of both liver and intestine. However, the pancreas contained visceral allograft that was preserved with HTK experienced a higher peak serum lipase levels(IU/L) compared to UW with a mean of 1030+1227 and 789+1064, respectively. Surgical intervention with pancreatic debridement was required for 7(16%) of HTK and 2(5%) of UW recipients. The allograft pancreatitis was fatal in one adult recipient due to rupture of an infected pseudoaneurysm that developed in the interpostion aortic graft. The pediatric pancreatic allografts were less susceptable to ischemia reperfusion injury with both solutions.

Conclusion: The use of HTK solution for vascular flushing and immersion of the composite visceral allografts that contained pancreas was associated with a significant high risk of post reperfusion syndrome and clinically significant allograft pancreatitis despite reduction in the volume of vascular flushing. It is our current practice to use UW solution for flushing and cooling of all of the pancreas contained composite visceral allografts.