Stevens R B, Skorupa J Y, Rigley T H, Yannam G R, Nielsen K J, Schriner M E, Skorupa A J, Murante A, Holdaway E, Wrenshall L E
Department of Surgery, Division of Transplantation, University of Nebraska Medical Center, Omaha, NE, USA.
Am J Transplant. 2009 May;9(5):1055-62. doi: 10.1111/j.1600-6143.2009.02624.x.
Histidine-Tryptophan-Ketoglutarate (HTK) solution is increasingly used to flush and preserve organ donor kidneys, with efficacy claimed equivalent to University of Wisconsin (UW) solution. We observed and reported increased graft pancreatitis in pancreata flushed with HTK solution, which prompted this review of transplanting HTK-flushed kidneys. We analyzed outcomes of deceased-donor kidneys flushed with HTK and UW solutions with a minimum of 12 months follow-up, excluding pediatric and multi-organ recipients. We evaluated patient and graft survival and rejection rates, variables that might constitute hazards to graft survival and renal function. Two-year patient survival, rejection, renal function and graft survival were not different, but early graft loss (<6 months) was worse in HTK-flushed kidneys (p < 0.03). A Cox analysis of donor grade, cold ischemic time, panel reactive antibodies (PRA), donor race, first vs. repeat transplant, rejection and flush solution showed that only HTK use predicted early graft loss (p < 0.04; relative risk = 3.24), almost exclusively attributable to primary non-function (HTK, n = 5 (6.30%); UW, n = 1 (0.65%); p = 0.02). Delayed graft function and early graft loss with HTK occurred only in lesser grade kidneys, suggesting it should be used with caution in marginal donors.
组氨酸 - 色氨酸 - 酮戊二酸（HTK）溶液越来越多地用于冲洗和保存器官捐献者的肾脏，据称其效果与威斯康星大学（UW）溶液相当。我们观察并报告了用HTK溶液冲洗的胰腺中移植后胰腺炎增加的情况，这促使我们对移植用HTK溶液冲洗的肾脏进行了此次回顾性研究。我们分析了用HTK溶液和UW溶液冲洗的已故供体肾脏的结果，随访时间至少为12个月，排除了儿科和多器官受者。我们评估了患者和移植物的存活率以及排斥率，这些变量可能对移植物存活和肾功能构成危害。两年的患者存活率、排斥率、肾功能和移植物存活率没有差异，但用HTK溶液冲洗的肾脏早期移植物丢失（<6个月）情况更糟（p < 0.03）。对供体等级、冷缺血时间、群体反应性抗体（PRA）、供体种族、首次移植与再次移植、排斥反应和冲洗溶液进行的Cox分析表明，只有使用HTK溶液可预测早期移植物丢失（p < 0.04；相对风险 = 3.24），几乎完全归因于原发性无功能（HTK组，n = 5（6.30%）；UW组，n = 1（0.65%）；p = 0.02）。HTK溶液导致的移植肾功能延迟和早期移植物丢失仅发生在等级较低的肾脏中，这表明在边缘供体中应谨慎使用。
