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. 2022 Sep;28(9):1454-1462.
doi: 10.1002/lt.26457. Epub 2022 Apr 25.

Preservation solutions for static cold storage in donation after circulatory death and donation after brain death liver transplantation in the United States

Thomas G Cotter  1 , Matthew A Odenwald, Angelica Perez-Gutierrez, Kumar Jayant, Diego DiSabato, Michael Charlton, John Fung
Affiliations

Preservation solutions for static cold storage in donation after circulatory death and donation after brain death liver transplantation in the United States

Thomas G Cotter et al. Liver Transpl. 2022 Sep.

Abstract

Static cold preservation remains the cornerstone for storing donor livers following procurement; however, the choice between University of Wisconsin solution (UW) and histidine-tryptophan-ketoglutarate solution (HTK) remains controversial. Recent International Liver Transplantation Society (ILTS) guidelines have recommended avoiding HTK for donation after circulatory death (DCD) grafts based on older reports. We studied the latest US adult graft outcomes in three recent eras (2006-2010, 2011-2015, 2016-2020) comparing HTK and UW among 5956 DCD LTs: 3873 (65.0%) used UW and 1944 (32.7%) used HTK. In a total of 82,679 donation after brain death (DBD) liver transplantations (LTs), 63,511 (76.8%) used UW and 15,855 (19.2%) used HTK. The HTK group had higher 1-year and 5-year graft survival rates of 89.7% and 74.3%, respectively, compared with 85.9% and 70.8% in the UW group in the 2016-2020 era (p = 0.005). This difference remained when adjusted for important potential confounders (hazard ratio, 0.78; 95% confidence interval: 0.60, 0.99). There were no differences between groups among DCD LTs in the earlier eras or among DBD LTs in all eras (all p values > 0.05). The latest US data suggest that HTK is at least noninferior to UW for preserving DCD livers. These data support HTK use in DCD LT and contradict ILTS guidance.

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Conflict of interest statement

Thomas G. Cotter, Matthew A. Odenwald, Angelica Perez‐Gutierrez, Kumar Jayant, Diego DiSabato, and John Fung have no relevant disclosures. Michael Charlton has received grant/research support and consultant fees from Gilead, received grant/research support from Conatus and Galectin and consultant fees from Metacrine, Enterome, Novartis, AbbVie, Intercept, and NGM Biopharmaceuticals.

Figures

FIGURE 1
FIGURE 1
Study flow diagram outlines the inclusions and exclusions of the study cohort
FIGURE 2
FIGURE 2
Annual number of (A) DCD and (B) DBD LTs in the United States from 2006 to 2020 stratified by static cold storage solution (UW vs. HTK vs. other/missing)
FIGURE 3
FIGURE 3
Graft survival rates among DCD LT recipients in the United States who received UW compared with HTK during static cold preservation stratified by eras ([A] 2006–2010, [B] 2011–2015, [C] 2016–2020)
FIGURE 4
FIGURE 4
Graft survival rates among DBD LT recipients in the United States who received UW compared with HTK during static cold preservation stratified by eras ([A] 2006–2010, [B] 2011–2015, [C] 2016–2020)
See this image and copyright information in PMC

Comment in

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