Histidine-Tryptophan-Ketoglutarate (HTK) Is Associated with Reduced Graft Survival in Deceased Donor Livers, Especially Those Donated After Cardiac Death
Histidine-Tryptophan-Ketoglutarate (HTK) Is Associated with Reduced Graft Survival in Deceased Donor Livers, Especially Those Donated After Cardiac Death
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DOI：
10.1111/j.1600-6143.2008.02478.x
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发表时间：
2009-02-01
影响因子：
8.8
通讯作者：
Segev, D. L.
中科院分区：
文献类型：
--
作者：
Stewart, Z. A.;Cameron, A. M.;Segev, D. L.
单中心研究报告称，与威斯康星州（UW）溶液相比，组氨酸-色氨酸-酮戊二酸（HTK）溶液中保存的肝移植物存活率不受影响。我们分析了从2004年7月到2008年2月进行的肝移植的UNOS数据库，以确定HTK（n = 4755）与UW（n = 12673）保存是否影响移植物存活。同种异体移植物的HTK保存率从2004年的16.8%上升到2008年的26.9%;这在心脏死亡（DCD）后的供体同种异体移植物中尤其引人注目，从2004年的20.7%上升到2008年的40.9%。在调整影响移植物存活的供体、受体和移植物因素后，HTK保存与移植物丢失风险增加相关（HR 1.14，p = 0.002），尤其是对于DCD同种异体移植物（HR 1.44，P = 0.025）和冷缺血时间超过8小时的移植物（HR 1.16，P = 0.009）。此外，HTK保留与早期发生的几率高出1.2倍相关。与UW保存相比，移植物丢失（< 30天）（OR 1.20，p = 0.012），对冷缺血时间超过8小时的同种异体移植物的影响更明显（OR 1.31，p = 0.007），DCD同种异体移植物（OR 1.63，p = 0.09）和70岁以上供体（OR 1.67，p = 0.081）。这些结果表明，越来越多地使用HTK腹部器官保存应重新审查。
Single-center studies have reported that liver allograft survival is not affected by preservation in histidine-tryptophan-ketoglutarate (HTK) versus University of Wisconsin (UW) solution. We analyzed the UNOS database of liver transplants performed from July, 2004, through February, 2008, to determine if preservation with HTK (n = 4755) versus UW (n = 12 673) impacted graft survival. HTK preservation of allografts increased from 16.8% in 2004 to 26.9% in 2008; this was particularly striking among donor after cardiac death (DCD) allografts, rising from 20.7% in 2004 to 40.9% in 2008. After adjusting for donor, recipient and graft factors that affect graft survival, HTK preservation was associated with an increased risk of graft loss (HR 1.14, p = 0.002), especially with DCD allografts (HR 1.44, P = 0.025) and those with cold ischemia time over 8 h (HR 1.16, P = 0.009). Furthermore, HTK preservation was associated with a 1.2-fold higher odds of early (< 30 days) graft loss as compared to UW preservation (OR 1.20, p = 0.012), with a more pronounced effect on allografts with cold ischemia time over 8 h (OR 1.31, p = 0.007), DCD allografts (OR 1.63, p = 0.09) and donors over 70 years (OR 1.67, p = 0.081). These results suggest that the increasing use of HTK for abdominal organ preservation should be reexamined.