Comparable outcome of liver transplantation with Histidine-Tryptophan-Ketoglutarate vs. University of Wisconsin preservation solution: a retrospective observational double-center trialReportar como inadecuado




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BMC Gastroenterology

, 14:169

Hepatobiliary and pancreatic disorders

Abstract

BackgroundThe question of whether the choice of preservation solution affects outcome after liver transplantation is still not satisfactorily answered. The purpose of this study is to examine the preservation solutions’ impact on outcome after liver transplantation.

MethodsA double-center retrospective study of short- and long-term results of 3134 consecutive liver transplantations with follow-up periods up to 23 years was performed applying multivariate, risk-adjusted analyses with a subset for living-donor transplants, pediatric transplants and cases with prolonged cold ischemic times. An additional focus was put on biliary complications. The primary study endpoints were short- and long-term patient survival and death-censored graft survival. Secondary study endpoints were the occurrence of post-transplant complications, the necessity of operative revisions, the length of hospital stay, and the length of intensive care unit stay.

ResultsAlthough long-term graft survival appears to be increased by Histidine-Tryptophan-Ketoglutarate-use p = 0.018, this effect could not be confirmed in risk-adjusted analysis p = 0.641. Multivariate regression analysis revealed that 3-month mortality p = 0.120, 3-month graft survival p = 0.103 and long-term patient survival p = 0.235 were not influenced by the choice of preservation solution. There was no difference in the occurrence of common complications or necessity of operative revisions after liver transplantation. This was confirmed in subgroup analyses for living donor and pediatric transplantation and cases with prolonged cold ischemic time. Analysis of the preservation solutions’ impact on length of hospital p = 0.113 and intensive care unit stay p = 0.481 revealed no significant difference.

ConclusionsUniversity of Wisconsin and Histidine-Tryptophan-Ketoglutarate solutions are clinically equivalent. Histidine-Tryptophan-Ketoglutarate solution could have an economically superior profile. The notion that the choice of preservation solution can have an impact on the onset of biliary complications after liver transplantation remains a matter of controversy.

KeywordsOrgan procurement Risk-adjusted analysis Prolonged cold ischemic time Biliary complications Economic evaluation AbbreviationsCITCold ischemic time

HATHepatic artery thrombosis

HCCHepatocellular carcinoma

HRHazard ratio

HTKHistidine-Tryptophane-Ketoglutarate solution

ICUIntensive care unit

LOSLength of hospital stay

LTXLiver transplantation

OROdds ratio

PSPreservation solution

PSCPrimary sclerosing cholangitis

PVTPortal vein thrombosis

SDStandard deviation

UWUniversity of Wisconsin solution

95%-CI95%-confidence interval.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-230X-14-169 contains supplementary material, which is available to authorized users.

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Autor: Alexander Kaltenborn - Jill Gwiasda - Volker Amelung - Christian Krauth - Frank Lehner - Felix Braun - Jürgen Klempnauer -

Fuente: https://link.springer.com/







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