CUSTODIOL
Perfusion and Preservation of Abdominal Organs
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Standard preservation solution for abdominal organs in the Eurotransplant region
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Preferred preservation solution by principal transplant centres in North and South America as well as by a steadily growing number of centres in Asia and Africa
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Suitable for multi-organ procurement (heart, liver, kidney, pancreas, composite tissue)
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Reliable protection of all kinds of organs, including those from non-heart beating donors
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High systemic tolerance due to low potassium concentration (10mM)
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Low viscosity guarantees optimal perfusion of the organ
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Highest available buffer capacity
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“Ready-to-use”
Comparison of CUSTODIOL and UW: Major differences10)
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CUSTODIOL
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UW (ViaSpan)
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Composition
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K+ low
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K+ high
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Viscosity (1°C)
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Low: 1.8cP, ≈water
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High: 6.2cP
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Flow
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Higher: x3
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Lower
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Cooling
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Faster
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Slower
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Additives
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Ready-to-use
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Several: e.g. fresh Glutathione
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Filters
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No
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Yes
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Flushing
(prior to implantation)
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Not necessary
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Mandatory (due to high K+)
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Adverse events
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None
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Cardiac arrest
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In situ protection
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Heart, kidney, liver
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No
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The Belzer solution developed at the University of Wisconsin (UW) contains a high concentration of K+ 125mmol/l. The theoretical benefit of high potassium concentration is faster cardiac arrest and less energy expenditure. However, animal studies demonstrated that hyperkalemic solution is detrimental to coronary vascular endothelium, which is consistent with current clinical studies and other animal studies. High potassium causes depolarization of the myocytes, enzyme dysfunction, decreases membrane stability, and Ca2+ sequestration (quote from Garlicki M, Kołcz J, Rudziński P, Kapelak B, Sadowski J, Wójcik S, Pietrzyk E, Frasik W, Drukała J, Dziatkowiak A. Myocardial protection for transplantation. Transplant Proc. 1999 Aug;31(5):2079-83)
10) According to table 1 in Ringe B, Braun F, Moritz M, Zeldin G, Soriano H, Meyers W. Safety and efficacy of living donor liver preservation with HTK solution. Transplant Proc. 2005;37:316-319
CUSTODIOL
The right choice for DCD and ECD
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Positive effects on the perfusion of grafts from ECD (extended criteria donor) and DCD (donation after cardiac death)
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Low viscosity solutions for perfusion are more effective for organs from DCD as they allow a better flush-out of the microcirculation, including the small peri-biliary capillaries
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Other solutions develop adenosine crystals at subzero temperatures, which can further exacerbate micro-circulatory embarrassment after reperfusion
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Crystalloid solutions are more likely to flush stagnant blood from the microvasculature in DCD organs than colloid-based preservation solutions
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CUSTODIOL helps preventing the adhesion of unwanted blood components (e.g. of leukocytes)
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High concentration of histidine buffer counteracts lactic acidosis in ischemic organs coming from non-heart-beating donors
