Histidine-tryptophan-ketoglutarate (HTK) is associated with reduced graft survival of deceased donor kidney transplants.
Stewart ZA, Lonze BE, Warren DS, Dagher NN, Singer AL, Montgomery RA, Segev DL. Am J Transplant. 2009 May;9(5):1048-54
University of Wisconsin (UW) solution has been the standard solution used for cold preservation for many years, while HTK is a newer, less expensive solution which appears to have several characteristics which would reduce ischemia-reperfusion injury. However, in this study from the UNOS database, HTK solution was associated with a late increased risk of death-censored graft loss, despite the lack of an impact on delayed graft function. There are no randomized controlled trials comparing these solutions, but this study may cause centers to reevaluate their use of HTK.
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Abstract:
Single-center studies have reported equivalent outcomes of kidney allografts recovered with histidine-tryptophan-ketoglutarate (HTK) or University of Wisconsin (UW) solution. However, these studies were likely underpowered and often unadjusted, and multicenter studies have suggested HTK preservation might increase delayed graft function (DGF) and reduce graft survival of renal allografts. To further inform clinical practice, we analyzed the United Network for Organ Sharing (UNOS) database of deceased donor kidney transplants performed from July 2004 to February 2008 to determine if HTK (n = 5728) versus UW (n = 15 898) preservation impacted DGF or death-censored graft survival. On adjusted analyses, HTK preservation had no effect on DGF (odds ratio [OR] 0.99, p = 0.7) but was associated with an increased risk of death-censored graft loss (hazard ratio [HR] 1.20, p = 0.008). The detrimental effect of HTK was a relatively late one, with a strong association between HTK and subsequent graft loss in those surviving beyond 12 months (HR 1.43, p = 0.007). Interestingly, a much stronger effect was seen in African-American recipients (HR 1.55, p = 0.024) than in Caucasian recipients (HR 1.18, p = 0.5). Given recent studies that also demonstrate that HTK preservation reduces liver and pancreas allograft survival, we suggest that the use of HTK for abdominal organ recovery should be reconsidered.
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