Rayya F, Harms J, Martin A P, Bartels M, Hauss J, Fangmann J
Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, University Leipzig, Leipzig, Germany.
Transplant Proc. 2008 May;40(4):891-4. doi: 10.1016/j.transproceed.2008.03.044.
A safe and effective preservation solution is a precondition for successful orthotopic liver transplantation (OLT). This study compared University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions in OLT.
We retrospectively reviewed the medical records of 137 primary cadaveric. OLT performed between January 2003 and December 2006 at our institution. Sixty-eight grafts were harvested using UW and 69 using HTK. Recipients were managed similarly in regard to operative techniques and immunosuppression. We collected donor data including serum transaminases, serum sodium, ICU stay and assessed macroscopic liver quality. Recipient serum transaminases were collected on postoperative days 1, 7, 14, and 30. We compared biliary and vascular complications, as well as patient and graft survivals.
Mean serum bilirubin levels were slightly higher in the HTK group at 1,7,14, and 30 days after transplantation, whereas transaminases were higher in the UW group. Primary nonfunction occurred in 1 patient in each group. Retransplantation was performed in 5 patients in the UW and in 9 patients in the HTK group. Biliary complication rates were similar in the UW and HTK groups (22% and 17%, respectively). Six arterial complications occurred in the HTK (8.7%) and 2 in the UW group (2.9%; P < .05). Mean follow-up was 25 months. Graft survival at 1, 12, and 36 months was 90%, 78%, and 75% versus 90%, 71%, and 71% in the UW versus HTK groups, respectively. One-, 12-, and 36-month patient survival rates were 93%, 78%, and 75% versus 93%, 78%, and 78% in the UW versus HTK groups, respectively.
There were no significant differences in graft and patient survivals between the 2 groups. Whereas the biliary complication rates were comparable in both groups, the arterial complications were clearly higher in the UW group (8.7% vs 2.9%; P < .05%). UW and HTK solutions seemed to be equally safe and effective in the preservation of liver grafts. The high incidence of arterial complications in the UW group requires further prospective studies.
一种安全有效的保存液是原位肝移植（OLT）成功的前提条件。本研究比较了威斯康星大学（UW）保存液和组氨酸 - 色氨酸 - 酮戊二酸（HTK）保存液在OLT中的应用效果。
我们回顾性分析了2003年1月至2006年12月在我院进行的137例初次尸体肝移植的病历资料。其中68例供肝采用UW保存液获取，69例采用HTK保存液获取。在手术技术和免疫抑制方面，对受体的处理方式相似。我们收集了供体数据，包括血清转氨酶、血清钠、重症监护病房（ICU）住院时间，并评估了肝脏大体质量。在术后第1、7、14和30天收集受体血清转氨酶数据。我们比较了胆系和血管并发症以及患者和移植物的存活率。
移植后第1、7、14和30天，HTK组的平均血清胆红素水平略高，而UW组的转氨酶水平较高。每组各有1例患者发生原发性无功能。UW组有5例患者进行了再次移植，HTK组有9例。UW组和HTK组的胆系并发症发生率相似（分别为22%和17%）。HTK组发生6例动脉并发症（8.7%），UW组发生2例（2.9%；P <.05）。平均随访时间为25个月。UW组和HTK组在1、12和36个月时的移植物存活率分别为90%、78%和75%以及90%、71%和71%。UW组和HTK组在1、12和36个月时的患者存活率分别为93%、78%和75%以及93%、78%和78%。
两组在移植物和患者存活率方面无显著差异。虽然两组的胆系并发症发生率相当，但UW组的动脉并发症明显更高（8.7%对2.9%；P <.05%）。UW和HTK保存液在保存肝移植物方面似乎同样安全有效。UW组动脉并发症的高发生率需要进一步的前瞻性研究。
