| Variables |
Number of patients without ITBL |
Number of patients with ITBL |
Incidence of ITBL |
|---|---|---|---|
| Number of patients | 1688 | 65 | 3.9% |
| Cold ischemia (min) | 558±218 | 652±242 | — |
| Perfusion solution UW/HTK | 1421 / 209 | 63 / 2 | 4.4% / 1% |
This study retrospectively evaluated 1843 patients. “The clinical consequences of this study for our institution have been the strict limitation of CIT to <10h and the exclusive use of HTK solution” (quote from the authors).
The water-like low viscosity of CUSTODIOL leads to a homogenous diffusion and quick cooling of the liver. Sinusoidal blood vessels will be gently and thoroughly perfused. This guarantees the protection of the hepatic microvasculature (vessels withless than 300µm and various morphological sites within these vessels that regulate the distribution of blood flow) and the peribiliary plexus of capillaries. In addition, the high buffering capacity provides an optimal protection against ischemia/reperfusion injuries caused by long cold ischemia times.
3) Heidenhain C, Pratschke J, Puhl G, Neumann U, Pascher A, Veltzke-Schlieker W, Neuhaus P. Incidence of and risk factors for ischemic-type biliary lesions following orthotopic liver transplantation. Transpl Int. 2010 Jan;23(1):14-22
| 1987-1992 | 1993-2000 | 2000-2007 | 2007-2013 | |
|---|---|---|---|---|
| HTK used | 0% | 8.3% | 44.7% | 87.0% |
| UW used | 100% | 91.7% | 55.3% | 13.0% |
| 3 months mortality (total) | 33.3% | 22.9% | 23.0% | 9.9% |
| Graft loss (total) | 88.9% | 61.5% | 49.7% | 26.5% |
| 3 month graft survival (total) | 66.7% | 70.8% | 69.7% | 81.1% |
The authors mention, that before application, several additives, such as prostaglandin E1 and/or dexamethason have to be added to UW solution. Once these components have been mixed, the solution must be used within 24h. In contrast, CUSTODIOL can be used right away and no further additives are needed. From a clinical point of view, CUSTODIOL can be quicker perfused without any need for pressurized perfusion. This is due to its comparatively low viscosity, which equals the one of water (2.0cP). The viscosity of UW is higher (6.2cP) because of the presence of colloids. An average of 8,303ml CUSTODIOLpreservation solution was used. Another important aspect in this context is the notion that with the introduction of MELD-based liver allocation and the “sickest-first principle” in Germany, patients accepted for a transplant tend to be sicker nowadays than in earlier eras. This might be also reflected in the increasing lengths of hospital and ICU stay (especially in era IV).
4) Kaltenborn A, Gwiasda J, Amelung V, Krauth C, Lehner F, Braun F, Klempnauer J, Reichert B, Schrem H. Comparable outcome of liver transplantation with histidine-tryptophan-ketoglutarate vs. University of Wisconsin preservation solution: a retrospective observational double-center trial. BMC Gastroenterol. 2014 Sep 28;14:169 (Table 3)
