Mangus Richard S, Tector A Joe, Fridell Jonathan A, Kazimi Marwan, Hollinger Edward, Vianna Rodrigo M
Department of Surgery, Transplantation Section, Indiana University School of Medicine, Indianapolis, IN 46202-5250, USA.
Transplantation. 2008 Jul 27;86(2):298-302. doi: 10.1097/TP.0b013e31817ef074.
Previous studies have failed to demonstrate a clinical difference between histidine-tryptophan-ketoglutarate (HTK) and University of Wisconsin (UW) preservation solutions in clinical transplant outcomes for liver, pancreas, and kidney transplantation. This study compares HTK and UW in bowel transplantation with primary outcomes being graft and patient survival, early graft function, and episodes of rejection.
Data were extracted using a retrospective chart and medical record review of all bowel transplants between 2003 and 2007, and included both pediatric and adult grafts. Transplanted organs included isolated small bowel, modified multivisceral (bowel, pancreas, and stomach) and multivisceral (bowel, pancreas, stomach, and liver). Immunosuppression included induction with a steroid taper and antithymocyte globulin and anti-CD20 monoclonal antibody (rituximab), followed by maintenance with prograf monotherapy. Bowel surveillance was performed with twice weekly zoom endoscopy and biopsy.
There were 54 patients transplanted with 57 grafts, 22 preserved in UW, and 37 in HTK. No differences were noted between the two solutions in initial graft function, appearance of bowel on initial endoscopy, and number of rejection episodes. There were no episodes of pancreatitis in the 44 multivisceral grafts which included a transplant pancreas (14 UW and 30 HTK). Kaplan-Meier survival analysis did not demonstrate a significant difference in graft or patient survival at 30- or 90-days posttransplant.
Intestinal grafts preserved in UW and HTK demonstrate no difference in graft and patient survival at 30- and 90-days posttransplant. There were no differences noted in initial function, endoscopic appearance, rejection episodes, or transplant pancreatitis.
先前的研究未能证实在肝、胰腺和肾移植的临床移植结局方面，组氨酸 - 色氨酸 - 酮戊二酸（HTK）保存液与威斯康星大学（UW）保存液之间存在临床差异。本研究比较了HTK和UW在肠道移植中的应用，主要结局指标为移植物和患者生存率、早期移植物功能以及排斥反应发作次数。
通过回顾性查阅2003年至2007年间所有肠道移植的病历和医疗记录来提取数据，包括儿科和成人移植物。移植器官包括孤立小肠、改良多脏器（肠道、胰腺和胃）和多脏器（肠道、胰腺、胃和肝脏）。免疫抑制包括使用类固醇递减联合抗胸腺细胞球蛋白和抗CD20单克隆抗体（利妥昔单抗）进行诱导，随后采用普乐可复单药维持治疗。通过每周两次的放大内镜检查和活检进行肠道监测。
54例患者接受了57次移植，22例使用UW保存液，37例使用HTK保存液。两种保存液在初始移植物功能、初次内镜检查时肠道外观以及排斥反应发作次数方面均未发现差异。在44例包含移植胰腺的多脏器移植物（14例UW保存液和30例HTK保存液）中未发生胰腺炎发作。Kaplan - Meier生存分析显示，移植后30天或90天时，移植物或患者生存率无显著差异。
UW和HTK保存的肠道移植物在移植后30天和90天时，移植物和患者生存率无差异。在初始功能、内镜外观、排斥反应发作次数或移植后胰腺炎方面均未发现差异。
