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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2015; 5(4): 154-164
Published online Dec 24, 2015. doi: 10.5500/wjt.v5.i4.154
Preservation solutions used during abdominal transplantation: Current status and outcomes
Nicholas Latchana, Joshua R Peck, Bryan A Whitson, Mitchell L Henry, Elmahdi A Elkhammas, Sylvester M Black
Nicholas Latchana, Department of Surgery, the Ohio State University Wexner Medical, Columbus, OH 43210, United States
Joshua R Peck, Department of Internal Medicine, Division of Gastroenterology, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Bryan A Whitson, Department of Surgery, Division of Cardiac Surgery, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Mitchell L Henry, Elmahdi A Elkhammas, Sylvester M Black, Department of Surgery, Division of Transplantation, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Latchana N and Peck JR drafted, reviewed, and revised the manuscript; Whitson BA, Henry ML and Elkhammas EA reviewed and edited the manuscript; Black SM conceptualized, reviewed and edited the manuscript.
Conflict-of-interest statement: All authors declare that they not have any competing commercial, personal, political, intellectual or religious interests in relation to the submitted work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sylvester M Black, MD, PhD, Assistant Professor of Surgery, Department of Surgery, Division of Transplantation, the Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210, United States. sylvester.black@osumc.edu
Telephone: +1-614-2938545 Fax: +1-614-2934541
Received: June 29, 2015
Peer-review started: July 2, 2015
First decision: August 4, 2015
Revised: October 15, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: December 24, 2015
Processing time: 177 Days and 1.2 Hours
Abstract

Organ preservation remains an important contributing factor to graft and patient outcomes. During donor organ procurement and transportation, cellular injury is mitigated through the use of preservation solutions in conjunction with hypothermia. Various preservation solutions and protocols exist with widespread variability among transplant centers. In this review of abdominal organ preservation solutions, evolution of transplantation and graft preservation are discussed followed by classification of preservation solutions according to the composition of electrolytes, impermeants, buffers, antioxidants, and energy precursors. Lastly, pertinent clinical studies in the setting of hepatic, renal, pancreas, and intestinal transplantation are reviewed for patient and graft survival as well as financial considerations. In liver transplants there may be some benefit with the use of histidine-tryptophan-ketoglutarate (HTK) over University of Wisconsin solution in terms of biliary complications and potential cost savings. Renal grafts may experience increased initial graft dysfunction with the use of Euro-Collins thereby dissuading its use in support of HTK which can lead to substantial cost savings. University of Wisconsin solution and Celsior are favored in pancreas transplants given the concern for pancreatitis and graft thrombosis associated with HTK. No difference was observed with preservation solutions with respect to graft and patient survival in liver, renal, and pancreas transplants. Studies involving intestinal transplants are sparse but University of Wisconsin solution infused intraluminally in combination with an intra-vascular washout is a reasonable option until further evidence can be generated. Available literature can be used to ameliorate extensive variation across centers while potentially minimizing graft dysfunction and improving associated costs.

Keywords: Graft preservation; Kidney; Liver; Pancreas; Intestine

Core tip: Preservation of abdominal organs during transplant remains an important factor in patient and graft survival. Considerable variation exists between institutions with respect to the preservation solution of choice with an uncertain impact on patient and graft survival. Herein, pertinent clinical studies were reviewed to highlight the best available evidence in the selection of preservation solutions for abdominal transplantation. Histidine-tryptophan-ketoglutarate (HTK) may improve the incidence of biliary complications in hepatic transplants while minimizing costs for renal transplants. However, the use of HTK is dissuaded in pancreas transplants in favor of University of Wisconsin and Celsior solutions given the potential for graft thrombosis with HTK.