HTK-preserved livers have significantly less risk of biliary leak

Richard S. Mangus, Chekar Kubal, Ray A. Chihara, Jonathan A. 
Fridell, Rodrigo M. Vianna, Timothy C. Borup, A. Joseph Tector. Transplant
 Division, Dept of Surgery, Indiana University School of Medicine, Indianapolis,
 IN

Objective: Histidine-tryptophan-ketoglutarate 
(HTK) and University of Wisconsin (UW) preservation solutions are the two
 solutions used primarily in abdominal organ procurement in the U.S. Bile duct
 complications are common in the post liver transplant (LT) period and may be
 related to the arterial blood supply for the biliary system. Because HTK is much 
less viscous than UW, it has been hypothesized that this solution provides a 
better flush of the biliary microcirculation. Improved blood clearance from
these small vessels may lower the risk for thrombus formation and improve
 post-transplant biliary perfusion leading to a lower risk of biliary
 complications. This study reviews the biliary complications in a large number of
 deceased donor LTs and compares outcomes for HTK and UW.

Methods: Data
 were extracted using a retrospective review of all liver transplants between 2001 and 2010, with an extensive review of all endoscopic and percutaneous 
biliary imaging and post-transplant liver function enzymes. Our center uses
 doppler ultrasound and biliary imaging as first evaluation for elevated liver
 enzymes, prior to biopsy, resulting in a large number of imaging studies.
 Primary outcomes included need for imaging, any leak, and stricture
 formation.

Results: There were 1185 LTs reviewed, including 1049 (89%)
 with duct-to-duct and 132 (11%) with Roux-Y reconstruction. (4 OR deaths) 
Preservation solution included 804 HTK (68%) and 369 UW (32%). 1-year graft 
survival was higher for the HTK preserved livers (90% vs 86%, p=0.06). Any 
biliary imaging was required for 55% of HTK and 61% of UW LTs (p=0.11). The risk
 of any leak was higher for UW (12%) versus HTK (5%) (p<0.001). The risk of
 anastomotic stricture was higher for HTK (42% vs 35%, p=0.07), but intrahepatic 
ischemic-type strictures were more common for UW preserved grafts (6% vs 2%,
p=0.02). Among donation after cardiac death (DCD) grafts, there were no
 significant differences in biliary complications, except for a much higher risk
 of intrahepatic ischemic-type strictures in UW-preserved grafts (46% vs 11%,
p<0.01).

Conclusion: HTK-preserved livers have significantly less 
risk of biliary leak and intrahepatic stricture formation when compared to 
UW-preserved grafts. UW has a much higher risk of intrahepatic strictures in DCD
 grafts when compared to HTK.

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