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Savier E, Brustia R, Golmard JL, Scatton O. Influence of 4 preservation solutions on ICU stay, graft and patient survival following liver transplantation. J Visc Surg 2019; 157:87-97. [PMID: 31548152 DOI: 10.1016/j.jviscsurg.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The goal of this study was to evaluate the prognostic role of four preservation solutions in liver transplantation (LT). PATIENTS AND METHODS This is a retrospective study originating from 22 French centers performing LT, registered in the prospective databank of the Cristal Biomedicine Agency between 2008 and 2013. The preservation solutions used were Celsior (CS), Institut Georges Lopez (IGL)-1, Solution de Conservation des Organes et des Tissus (SCOT) 15 and University of Wisconsin (UW) solutions. Exclusion criteria were preservation with unknown or inhomogeneous solutions, or Histidine-tryptophan-ketoglutarate (HTK) solution (representing only 3% of LT). Patient survival was the main endpoint. Secondary endpoints were graft survival and duration of stay in intensive care. RESULTS Of 6347 LT performed, 4928 were included in this study, for which the distribution of preservation solution was CS (30%), IGL-1 (44%), SCOT 15 (10%) and UW (16%). Patient survival was 86%, 80% and 74% at 1, 3 and 5 years after LT, respectively, without any statistically significant difference between the four solutions (P=0.78). Graft survival was 82%, 75% and 69% at 1, 3 and 5 years after LT, respectively, without any statistically significant difference between the four solutions (P=0.80). Duration of intensive care was different according to the solution used in univariate analysis (P<0.001), but this effect disappeared in multivariate analysis when the center performing the transplantation was accounted for. CONCLUSION The type of preservation solution used (CS, IGL-1, SCOT 15 or UW) did not have any influence on patient or graft survival after LT.
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Affiliation(s)
- E Savier
- Service de chirurgie digestive, hépato-bilio-pancréatique et transplantation hépatique, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47-83, boulevard de l'Hôpital, 75651, Paris cedex 13, France; Centre de recherche Saint-Antoine, faculté de médecine Saint-Antoine, Inserm, Sorbonne université UMR_S 938, 27, rue de Chaligny, 75571 Paris cedex 12, France.
| | - R Brustia
- Service de chirurgie digestive, hépato-bilio-pancréatique et transplantation hépatique, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47-83, boulevard de l'Hôpital, 75651, Paris cedex 13, France; Unité de recherche BQR SSPC « simplification des soins des patients complexes », université de Picardie Jules Verne, 80080 Amiens, France
| | - J-L Golmard
- Unités de recherche clinique (URC) cfx Pitié-Salpêtrière (HUPSLCFX), faculté de médecine, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 75013 Paris, France
| | - O Scatton
- Service de chirurgie digestive, hépato-bilio-pancréatique et transplantation hépatique, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47-83, boulevard de l'Hôpital, 75651, Paris cedex 13, France; Centre de recherche Saint-Antoine, faculté de médecine Saint-Antoine, Inserm, Sorbonne université UMR_S 938, 27, rue de Chaligny, 75571 Paris cedex 12, France
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2
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Carnevale ME, Lausada N, Juan de Paz L, Stringa P, Machuca M, Rumbo M, Guibert EE, Tiribelli C, Gondolesi GE, Rodriguez JV. The Novel N,N-bis-2-Hydroxyethyl-2-Aminoethanesulfonic Acid-Gluconate-Polyethylene Glycol-Hypothermic Machine Perfusion Solution Improves Static Cold Storage and Reduces Ischemia/Reperfusion Injury in Rat Liver Transplant. Liver Transpl 2019; 25:1375-1386. [PMID: 31121085 DOI: 10.1002/lt.25573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/16/2019] [Indexed: 01/19/2023]
Abstract
Organ transplantation is the treatment of choice against terminal and irreversible organ failure. Optimal preservation of the graft is crucial to counteract cold ischemia effects. As we developed an N,N-bis-2-hydroxyethyl-2-aminoethanesulfonic acid-gluconate-polyethylene glycol (BGP)-based solution (hypothermic machine perfusion [HMP]), we aimed to analyze the use of this solution on static cold storage (SCS) of rat livers for transplantation as compared with the histidine tryptophan ketoglutarate (HTK) preservation solution. Livers procured from adult male Sprague Dawley rats were preserved with BGP-HMP or HTK solutions. Liver total water content and metabolites were measured during the SCS at 0°C for 24 hours. The function and viability of the preserved rat livers were first assessed ex vivo after rewarming (90 minutes at 37°C) and in vivo using the experimental model of reduced-size heterotopic liver transplantation. After SCS, the water and glycogen content in both groups remained unchanged as well as the tissue glutathione concentration. In the ex vivo studies, livers preserved with the BGP-HMP solution were hemodynamically more efficient and the O2 consumption rate was higher than in livers from the HTK group. Bile production and glycogen content after 90 minutes of normothermic reperfusion was diminished in both groups compared with the control group. Cellular integrity of the BGP-HMP group was better, and the histological damage was reversible. In the in vivo model, HTK-preserved livers showed a greater degree of histological injury and higher apoptosis compared with the BGP-HMP group. In conclusion, our results suggest a better role of the BGP-HMP solution compared with HTK in preventing ischemia/reperfusion injury in the rat liver model.
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Affiliation(s)
- Matías E Carnevale
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Rosario, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina
| | - Natalia Lausada
- Cátedra de Trasplante, Facultad de Ciencias Médicas, Universidad Nacional de la Plata, La Plata, Argentina
| | - Leonardo Juan de Paz
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Rosario, Argentina
| | - Pablo Stringa
- Cátedra de Trasplante, Facultad de Ciencias Médicas, Universidad Nacional de la Plata, La Plata, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina
| | - Mariana Machuca
- Laboratorio de Patología Especial, Facultad de Ciencias Veterinarias, Universidad Nacional de la Plata, La Plata, Argentina
| | - Martin Rumbo
- Instituto de Estudios Inmunológicos y Fisiopatológicos, Universidad Nacional de la Plata, La Plata, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina
| | - Edgardo E Guibert
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Rosario, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina
| | | | - Gabriel E Gondolesi
- Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina.,Servicio de Cirugía General, Trasplante Hepático, Pancreático e Intestinal, Hospital Universitario Fundación Favaloro, Laboratorio de Microcirugía Experimental, Instituto de Medicina Traslacional, Trasplante y Bioengeniería, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Favaloro, Buenos Aires, Argentina
| | - Joaquin V Rodriguez
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada, Universidad Nacional de Rosario, Rosario, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de la Plata, La Plata, Argentina
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3
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Husen P, Hornung J, Benko T, Klein C, Willuweit K, Buechter M, Saner FH, Paul A, Treckmann JW, Hoyer DP. Risk Factors for High Mortality on the Liver Transplant Waiting List in Times of Organ Shortage: A Single-Center Analysis. Ann Transplant 2019; 24:242-251. [PMID: 31048668 PMCID: PMC6519305 DOI: 10.12659/aot.914246] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Germany has the highest rate of patients dying or becoming unfit for transplant while waitlisted within the Eurotransplant region. Therefore, the aim of the current study was to analyze mortality as well as risk factors for mortality of candidates listed for liver transplantation at our center. MATERIAL AND METHODS Between 01/2011 and 12/2013, 481 adult patients were listed for primary liver transplantation (LT) at a single German center. Clinical and laboratory parameters were prospectively collected and retrospectively analyzed by univariable and multivariable logistic regression and Cox proportional hazards. RESULTS The mean model for end-stage liver disease (MELD) score of all liver transplant waitlist registrants (52.4 years, 60.1% male) was 16.9 (±10.2) at time of listing, with 10% of the listed patients having a MELD score of >32. After waitlisting, 133 (27.7%) candidates died within the follow-up period. Three-month-survival after listing for transplantation was 89% for patients ultimately receiving LT vs. 71.2% that did not receive LT (p<0.001). Multivariable analysis identified clinical parameters such as ICU treatment, preceding abdominal surgery, variceal bleeding, and ascites, as well as hydropic decompensation, as independent risk factors for waitlist mortality. CONCLUSIONS Consideration of independent risk factors of mortality within the MELD-based allocation system potentially improves assessment of individual urgency and might improve utilization of available organs.
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Affiliation(s)
- Peri Husen
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Julian Hornung
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tamas Benko
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Klein
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Katharina Willuweit
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Matthias Buechter
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fuat Hakan Saner
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Juergen Walter Treckmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dieter Paul Hoyer
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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4
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The Effect of Histidine-tryptophan-ketoglutarate Solution and University of Wisconsin Solution: An Analysis of the Eurotransplant Registry. Transplantation 2018; 102:1870-1877. [DOI: 10.1097/tp.0000000000002406] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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5
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Hameed AM, Laurence JM, Lam VWT, Pleass HC, Hawthorne WJ. Reply. Liver Transpl 2018; 24:1144-1146. [PMID: 29742806 DOI: 10.1002/lt.25195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 10/31/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Ahmer M Hameed
- Center for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.,Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Jerome M Laurence
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Vincent W T Lam
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Henry C Pleass
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Wayne J Hawthorne
- Center for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.,Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
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Szilágyi ÁL, Mátrai P, Hegyi P, Tuboly E, Pécz D, Garami A, Solymár M, Pétervári E, Balaskó M, Veres G, Czopf L, Wobbe B, Szabó D, Wagner J, Hartmann P. Compared efficacy of preservation solutions on the outcome of liver transplantation: Meta-analysis. World J Gastroenterol 2018; 24:1812-1824. [PMID: 29713134 PMCID: PMC5922999 DOI: 10.3748/wjg.v24.i16.1812] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/02/2018] [Accepted: 04/09/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the effects of the four most commonly used preservation solutions on the outcome of liver transplantations. METHODS A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the Cochrane Library databases up to January 31st, 2017. The inclusion criteria were comparative, randomized controlled trials (RCTs) for deceased donor liver (DDL) allografts with adult and pediatric donors using the gold standard University of Wisconsin (UW) solution or histidine-tryptophan-ketoglutarate (HTK), Celsior (CS) and Institut Georges Lopez (IGL-1) solutions. Fifteen RCTs (1830 livers) were included; the primary outcomes were primary non-function (PNF) and one-year post-transplant graft survival (OGS-1). RESULTS All trials were homogenous with respect to donor and recipient characteristics. There was no statistical difference in the incidence of PNF with the use of UW, HTK, CS and IGL-1 (RR = 0.02, 95%CI: 0.01-0.03, P = 0.356). Comparing OGS-1 also failed to reveal any difference between UW, HTK, CS and IGL-1 (RR = 0.80, 95%CI: 0.80-0.80, P = 0.369). Two trials demonstrated higher PNF levels for UW in comparison with the HTK group, and individual studies described higher rates of biliary complications where HTK and CS were used compared to the UW and IGL-1 solutions. However, the meta-analysis of the data did not prove a statistically significant difference: the UW, CS, HTK and IGL-1 solutions were associated with nearly equivalent outcomes. CONCLUSION Alternative solutions for UW yield the same degree of safety and effectiveness for the preservation of DDLs, but further well-designed clinical trials are warranted.
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Affiliation(s)
| | - Péter Mátrai
- Institute of Bioanalysis, University of Pécs, Pécs H-7624, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary
- MTA-SZTE Translational Gastroenterology Research Group, Szeged H-6720, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs H-7624, Hungary
| | - Eszter Tuboly
- Institute of Surgical Research, University of Szeged, Szeged H-6720, Hungary
| | - Daniella Pécz
- Institute of Surgical Research, University of Szeged, Szeged H-6720, Hungary
| | - András Garami
- Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Margit Solymár
- Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Erika Pétervári
- Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Márta Balaskó
- Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Gábor Veres
- 1st Department of Paediatrics, University of Semmelweis, Budapest H-1085, Hungary
| | - László Czopf
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Bastian Wobbe
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Dorottya Szabó
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Juliane Wagner
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Petra Hartmann
- Institute of Surgical Research, University of Szeged, Szeged H-6720, Hungary
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7
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Adam R, Cailliez V, Karam V. Evaluation of HTK Preservation Solutions in Liver Transplantation: A Long-Term Propensity-Based Analysis of Outcome From the European Liver Transplant Registry. Am J Transplant 2017; 17:585-586. [PMID: 27516047 DOI: 10.1111/ajt.14009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R Adam
- Centre Hépatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U 935, Univ Paris Sud, Villejuif, France
| | - V Cailliez
- Centre Hépatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U 935, Univ Paris Sud, Villejuif, France
| | - V Karam
- Centre Hépatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U 935, Univ Paris Sud, Villejuif, France
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8
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Adam R, Delvart V, Karam V. Reply to Letter Regarding "Compared Efficacy of Preservation Solutions in Liver Transplantation: A Long-Term Graft Outcome Study From the European Liver Transplant Registry". Am J Transplant 2015; 15:3274-5. [PMID: 26555219 DOI: 10.1111/ajt.13512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/24/2015] [Accepted: 08/31/2015] [Indexed: 01/25/2023]
Affiliation(s)
- R Adam
- European Liver Transplant Registry Coordinating Committee, Centre Hepatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U935, Université Paris Sud, Villejuif, France
| | - V Delvart
- European Liver Transplant Registry Coordinating Committee, Centre Hepatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U935, Université Paris Sud, Villejuif, France
| | - V Karam
- European Liver Transplant Registry Coordinating Committee, Centre Hepatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U935, Université Paris Sud, Villejuif, France
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