Preservation solutions used during abdominal transplantation: Current status and outcomes

Abstract

Organ preservation remains an important contributing factor to graft and patient outcomes. During donor organ procurement and transportation, cellular injury is mitigated through the use of preservation solutions in conjunction with hypothermia. Various preservation solutions and protocols exist with widespread variability among transplant centers. In this review of abdominal organ preservation solutions, evolution of transplantation and graft preservation are discussed followed by classification of preservation solutions according to the composition of electrolytes, impermeants, buffers, antioxidants, and energy precursors. Lastly, pertinent clinical studies in the setting of hepatic, renal, pancreas, and intestinal transplantation are reviewed for patient and graft survival as well as financial considerations. In liver transplants there may be some benefit with the use of histidine-tryptophan-ketoglutarate (HTK) over University of Wisconsin solution in terms of biliary complications and potential cost savings. Renal grafts may experience increased initial graft dysfunction with the use of Euro-Collins thereby dissuading its use in support of HTK which can lead to substantial cost savings. University of Wisconsin solution and Celsior are favored in pancreas transplants given the concern for pancreatitis and graft thrombosis associated with HTK. No difference was observed with preservation solutions with respect to graft and patient survival in liver, renal, and pancreas transplants. Studies involving intestinal transplants are sparse but University of Wisconsin solution infused intraluminally in combination with an intra-vascular washout is a reasonable option until further evidence can be generated. Available literature can be used to ameliorate extensive variation across centers while potentially minimizing graft dysfunction and improving associated costs.

Keywords: Graft preservation; Kidney; Liver; Pancreas; Intestine

Core tip: Preservation of abdominal organs during transplant remains an important factor in patient and graft survival. Considerable variation exists between institutions with respect to the preservation solution of choice with an uncertain impact on patient and graft survival. Herein, pertinent clinical studies were reviewed to highlight the best available evidence in the selection of preservation solutions for abdominal transplantation. Histidine-tryptophan-ketoglutarate (HTK) may improve the incidence of biliary complications in hepatic transplants while minimizing costs for renal transplants. However, the use of HTK is dissuaded in pancreas transplants in favor of University of Wisconsin and Celsior solutions given the potential for graft thrombosis with HTK.