Combined Flush With Histidine-Tryptophan-Ketoglutarate and University of Wisconsin Solutions in Liver Transplantation: Preliminary Results.Leon Diaz FJ, Fernandez Aguilar JL, et al.
Transplantation Proceedings. 2018; 50(2):539-42.
To compare ischemia reperfusion injury (IRI0, early allograft dysfunction (EAD), and primary allograft failure (PAF) in liver transplantation in a cohort of patients perfused with histidine-tryptophan ketoglutarate (HTK) solution and University of Wisconsin (UW) solution versus HTK alone.
80 patients were randomized (1:1) to receive perfusion with either HTK + UW or to HTK alone (n=40 in each group). This paper presents data for the first 20 patients assigned to each group.
40 liver transplant patients randomized to HTK + UW (n=20) or to HTK (n=20).
Primary endpoints included IRI, EAD, PAF, re-intervention, acute cellular rejection, retransplantation, arterial complications, and biliary complications at postoperative Day 90.
Post-operative Day 90.
The scientific rationale for mixing preservation fluids is not clearly explained in this study, other than in an attempt to reduce ischaemia-reperfusion injury. Perhaps comparing HTK with UW directly would have been a better comparison. This study is probably too small to be adequately powered for any of the multiple primary endpoints listed. Serum levels of glutamic oxaloacetic transaminase and glutamic pyruvic transaminase were higher in the HTK group. The study was not blinded, and there is no thorough description of withdrawals and dropouts. This study does not give strong evidence to support the mixing of preservation fluids, a process that may have unintended consequences.