Minimization of damage from cold ischemia and reperfusion is critical to the success of solid organ transplantation. Extensive research has focused on the optimization of organ preservative solutions. The ideal preservation solution has not yet been established and a variety of commercial preservation solutions are today used worldwide, including University of Wisconsin (UW) solution, Celsior solution, low potassium dextran (LPD) solution, histidine-tryptophan-ketoglutarate (HTK) solution, Euro-Collins solution, Institut Georges Lopez (IGL-1) solution...
We have a high load liver tranplantation program in shiraz transplant center, Shiraz, Iran, under supervision of Dr Seyed Ali Malekhosseini with more than 350 procedure per year. For a short period we used HTK as the main preservation solution insteadof UW. But very soon our mortality and morbidity incresed considerably and Dr Malekhosseini abondoned the use of HTK. During that short period many of our patient had enzymatic changes consistent with preservation injury and also we had 3 cases of primary nonfunction of unknown cause but we didn't published our results. We strongly recommend the use ofUW solution until a better solution is introduced becauseof the high cost and disaterous complications of liver transplantation failure for the patients.
An interesting question to which we know some answers. Euro-Collins on it's own is not accepatble for liver transplantation-and the early pioneers in liver transplantation all knew this, hence why UW solution was developed and felt to be a breakthrough at the time it came into practice.
I personally have concerns wrt HTK particularly in the DCD liver transplant setting(this was prior to the retrospective analysis of the US registry data which revealed inferior outcomes with use of HTK versus UW published in the American Journal of Transplantation 2009; 9:286-293). Only a well funded prospective randomised trial would answer your question but in the current economic climate it is hard to envision.
Maybe extra-corporeal liver transplantation will at some stage bring that added dimension into practice for liver transplantation which we need-ie better preservation.
Thank you Deborah and Farzad for sharing your experience.
Farzad. Are all the other Iranian centers using exclusively UW now?
Deborah. It is clear that an urgent consensus is necessary. Waiting for the results of a clinical trial could take a long time.
Is your respective health organizations aware about the impact of the preservation solution on the graft function?
Yes, the other liver transplant centers use only UW solution for liver transplantation.
As known, UW solution is a "gold standard" in transplantology but now so many controversial relations to this solution exist. It was shown a lot of side effects of this solution.
Our laboratory for a long time investigates this problem, we elaborated own sucrose-based solution and it's not worse than UW in all experiments but... On the one hand, unfortunately, till today we don't have any ability to estimate its efficacy after real transplantation; on the other hand, we propose some ways, which, under experimental conditions, are able to augment strongly liver state and function after long-term preservation.
On my opinion, UW solution priority is lobbied strongly by manufacturer and this limit hampers the qualitative leap in this area.
Yes, certainly in this part of the world there is some awareness of the differences between the preservation solutions.
There is a Multi-Abdominal Organ solution produced in France by Macopharma called SCOT 15; a rinsing and hypothermic preservation solution for abdominal grafts (kidney, liver, pancreas), from removal from the donor to implantation in the recipient.
Ignacio,
Thank you for this information. SCOT 15 and IGL-1 which are considered as the 4th generation of solutions seem to be associated with good results presumably thanks to the PEG component. But is there a randomized study who shows the superiority (or at least the equivalence) of SCOTT 15 (or IGL-1) with comparison to UW for graft liver preservation?
You will find complementary information regarding this topic in our publication available in my contributions to RG. Indeed, we published in AJT the results of the analysis of ELTR data regarding the different preservation solutions used in Europe. Colleagues from Hamburg, DTG and DSO have sent a letter to the Editor regarding our paper. This letter and our response were published online on AJT last week. We are very thankful to our German colleagues because the additional analyses that they requested, have reinforced the conclusion of our original paper.
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