Roels L, Coosemans W, Donck J, Maes B, Peeters J, Vanwalleghem J, Pirenne J, Vanrenterghem Y
Department of Transplantation Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
Transplantation. 1998 Dec 27;66(12):1660-4. doi: 10.1097/00007890-199812270-00015.
During recent years, an increasing number of transplant centers within the Eurotransplant organization have used histidine-tryptophan-ketoglutarate (HTK) solution instead of University of Wisconsin (UW) solution as their preferred cold storage solution for abdominal organ preservation. We report on our single-center experience on the outcome of imported kidneys preserved with either HTK or UW solution in relation to the duration of cold ischemia time (CIT).
Between July 1989 and July 1997, 323 cadaveric kidneys preserved with UW or HTK and imported as a result of an exchange within the Eurotransplant organization were transplanted at our institution. CIT was <24 hr in 216 kidneys (UW: n=174, HTK: n=42) and > or =24 hr in 107 kidneys (UW: n=67, HTK: n=40). Renal functional outcome was evaluated by comparing delayed graft function and initial non-function rates, daily urinary output, the evolution of serum creatinine, and creatinine clearance at 1, 3, 5, 7, and 14 days and at 1, 3, 6 and 12 months, and graft survival at 1 year after transplantation in relation to the type of cold storage solution and CIT < or > or =24 hr.
Whereas the incidence of delayed graft function did not differ significantly between kidneys preserved for less than 24 hr in UW (18.6%) or HTK (26.2%), this rate increased to 50% in HTK kidneys compared to 23.9% in UW kidneys when CIT exceeded 24 hr (P=0.006). Mean serum creatinine and creatinine clearance values were better at 1 and 5 days postoperatively in kidneys preserved <24 hr with UW as compared to HTK (P<0.05). After 24 hr of CIT, HTK-preserved kidneys showed an impaired renal function, not only in the immediate postoperative phase but also at 1, 3, 6, and 12 months after transplantation (P<0.05). Graft survival at 1 year was 92.9% in UW vs. 87.5% in HTK kidneys preserved for <24 hr (NS), and 91% vs. 77.4% when CIT exceeded 24 hr (P=0.059).
From these single-center findings, it can be concluded that UW is superior to HTK in kidney preservation, particularly when CIT exceeds 24 hr.
近年来，欧洲器官移植组织内越来越多的移植中心使用组氨酸 - 色氨酸 - 酮戊二酸（HTK）溶液而非威斯康星大学（UW）溶液作为腹部器官保存的首选冷保存溶液。我们报告了我们单中心关于用HTK或UW溶液保存的进口肾脏的结果与冷缺血时间（CIT）的关系的经验。
1989年7月至1997年7月期间，我们机构移植了323个用UW或HTK保存并因欧洲器官移植组织内的交换而进口的尸体肾脏。216个肾脏的CIT<24小时（UW：n = 174，HTK：n = 42），107个肾脏的CIT≥24小时（UW：n = 67，HTK：n = 40）。通过比较移植肾功能延迟和初始无功能发生率、每日尿量、血清肌酐的变化以及1、3、5、7和14天以及1、3、6和12个月时的肌酐清除率，以及移植后1年时与冷保存溶液类型和CIT<或≥24小时相关的移植肾存活情况，评估肾功能结果。
UW保存时间少于24小时的肾脏（18.6%）和HTK保存时间少于24小时的肾脏（26.2%）之间移植肾功能延迟的发生率无显著差异，而当CIT超过24小时时，HTK保存的肾脏中该发生率增至50%，而UW保存的肾脏中为23.9%（P = 0.006）。与HTK相比，UW保存<24小时的肾脏术后1天和5天时的平均血清肌酐和肌酐清除率值更好（P<0.05）。CIT达到24小时后，HTK保存的肾脏不仅在术后即刻而且在移植后1、3、6和12个月时肾功能均受损（P<0.05）。UW保存<24小时的肾脏1年时移植肾存活率为92.9%，HTK保存的肾脏为87.5%（无显著差异），当CIT超过24小时时，分别为91%和77.4%（P = 0.059）。
从这些单中心研究结果可以得出结论，在肾脏保存方面UW优于HTK，尤其是当CIT超过24小时时。
