Title: Comparison of HTK and UW in Abdominal Transplantation
1Comparison of HTK and UW in Abdominal
Transplantation
- Dr. Richard S. Mangus, MD MS
- Indiana University, School of Medicine
2OUTLINE
- Conversion from UW to HTK
- Indiana Organ Procurement Organization
- Indiana University
- Transplant outcomes UW vs HTK
- Kidney transplantation
- Pancreas transplantation
- Liver transplantation
- Intestinal transplantation
- Future research
3Indiana Organ Procurement Organization (IOPO)
- Service area Indiana
- Population 5.1 million
- Hospitals 130
- Transplant centers 7
4Indiana Organ Procurement Organization (IOPO)
- Potential advantages to HTK
- Decreased cost
- Decrease contamination risk
- No mixing
- No filter
- Longer shelf life
- Can store at cool room temperature
- Faster preparation time for coordinator
- - hang it, spike it , infuse it
5Indiana Organ Procurement Organization (IOPO)
- Potential advantages to HTK
- Improved organ flushing
- Lower viscosity
- Faster organ cooling
- No organ flushing before reperfusion
- Lower K load decreases risks of hyperkalemia
and bradycardia - Easier to work with on back bench
- ? Improved outcomes
6Indiana Organ Procurement Organization (IOPO)
- Cost analysis HTK vs UW
- UW flush volume / donor 3.5 liters
- UW cost / liter 306.00
- Total cost per donor 1071
- HTK flush volume / donor 3.5 liters
- HTK cost / liter 150.00
- Total cost per donor 525
- Cost savings per donor 546
7Indiana Organ Procurement Organization (IOPO)
- Center cost savings
- Cost savings / donor 546
- Annual cost savings
- for average OPO (200 donors) 109,200
8Indiana University Medical Center
- Abdominal Organ Transplants
- Liver
- Pancreas
- Kidney
- Islets
- Small intestine / Multivisceral
9Indiana University Medical Center
- Abdominal Organ Transplants
- 2007 Rank
- Liver 155 Top 5
- Pancreas 84 1st
- Kidney 255 Top 10
- Small intestine 22 Top 5
- OVERALL ( thoracic) 562 Top 5
www.unos.org, 2007 data report
10Transplant Volume
11Transplant Volume
Conversion to HTK
12- Natural Experiment
- A naturally occurring instance which approaches
or duplicates a scientific experiment. In
contrast to laboratory experiments, these events
aren't created by scientists, but yield
scientific data. Natural experiments are a common
research tool in fields where artificial
experimentation is difficult, such as
epidemiology.
13Renal Transplantation
14Renal Transplantation
Transplants 1990 to 1992 DGF Need for
dialysis 2 or more times during first 7-days
post-transplant Flush volume HTK 5 6
L UW 1 2 L EC 4 L
15Renal Transplantation
de Boer, et al, Transpl Proc, 1999 31 2065
16Renal Transplantation
de Boer, et al, Transpl Proc, 1999 31 2065
17HTK vs UW KIDNEY Transplantation
- N91 renal transplants HTK 50 UW 41
- No differences in Delayed graft function
- Graft survival
- Patient survival
-
18Creatinine Clearance Post Transplantation
100
80
60
UW
ml/min
HTK
40
20
0
1
2
3
4
5
6
7
10
14
21
30
time (days)
19(No Transcript)
20HTK vs UW Kidney Transplantation
- N149 renal transplants
- gt 16 hrs HTK 62, UW 87
- No difference patient / graft survival
- HTK lower DGF (24 vs 56, plt0.01)
- gt 24 hrs HTK 31, UW 38
- No difference in patient / graft survival
- HTK lower DGF (16 vs 56, plt0.05)
21PANCREAS TRANSPLANTATION
22Pancreas Transplantation
- N 20 pancreas transplants HTK 10 UW 10
- No differences in Graft survival
- Patient survival
- Serum fasting blood glucose
- Peak serum amylase
- Serial amylase levels
23Pancreas Transplantation
24Pancreas Transplantation
- N 87 pancreas transplants HTK 78 UW 9
- No differences in Graft survival
- Patient survival
- Serum fasting blood glucose
- Peak serum amylase
- Serial amylase levels
25Pancreas Transplantation
26Pancreas Transplantation
Primary preservation solution HTK, 2003 to 2007
27Pancreas Islet Transplantation
28Pancreas Islet Transplantation
29LIVER TRANSPLANTATION
30Liver Transplantation
- N378 liver transplants HTK 174 UW 204
31Liver Transplantation ECD
N698 liver transplants HTK 371 UW
327 Groups Standard 209 (30) ECD (old
age) 70 (10) ECD (physiologic stress) 435
(62)
32Liver Transplantation ECD
33Liver Transplantation ECD
N698 HTK 371 UW 327
34Liver Transplantation ECD
Standard donors, n209
Extended criteria donors, n489
35Liver Transplantation ECD
Donor 60 years, n70
Donor lt 60 years, n628
36Liver Transplantation ECD
No physiologic stress, n263
Physiologic ECD, n435
37Liver Transplantation ECD
38Liver Transplantation
39Liver Transplantation
40Liver Transplantation
Donation after cardiac death, n43 HTK 35 UW
7
41Liver Transplantation Recent
42Intestinal / Multivisceral Transplantation
43Intestinal Transplantation
- Comparison of HTK and UW in Intestinal and
Multivisceral Transplantation - - Mangus, et al. Transplantation, 2008 In Press
N57 intestinal transplants HTK 35 UW 22
44Intestinal Transplantation
45Intestinal Transplantation
N57 intestinal transplants HTK 35 UW 22
46Intestinal Transplantation
- No difference between HTK and UW in graft and
patient survival at 30- and 90-days, and 1-year
post-transplant - No differences noted in
- Initial function
- Appearance on early magnification endoscopy
- Rejection episodes
- Transplant pancreatitis
47CONCLUSIONS
- Cost savings associated with HTK use
- No demonstrated difference in outcomes for
kidney - pancreas
- pancreatic islets
- liver
- intestine
- Possible decrease in biliary complications for
HTK in liver transplantation - Possible long-term improvement in survival with
HTK in liver transplantation
48HTK vs UW FUTURE RESEARCH
- HTK vs UW
- Prolonged cold ischemia time
- Transplant pancreatitis
- DCD allografts
- Biliary complications / Flush of microcirculation
- Multicenter data large volume data analysis