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Comparison of HTK and UW in Abdominal Transplantation

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Title: Comparison of HTK and UW in Abdominal Transplantation


1
Comparison of HTK and UW in Abdominal
Transplantation
  • Dr. Richard S. Mangus, MD MS
  • Indiana University, School of Medicine

2
OUTLINE
  • 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

3
Indiana Organ Procurement Organization (IOPO)
  • Service area Indiana
  • Population 5.1 million
  • Hospitals 130
  • Transplant centers 7

4
Indiana 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

5
Indiana 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

6
Indiana 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

7
Indiana Organ Procurement Organization (IOPO)
  • Center cost savings
  • Cost savings / donor 546
  • Annual cost savings
  • for average OPO (200 donors) 109,200

8
Indiana University Medical Center
  • Abdominal Organ Transplants
  • Liver
  • Pancreas
  • Kidney
  • Islets
  • Small intestine / Multivisceral

9
Indiana 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
10
Transplant Volume
11
Transplant 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.

13
Renal Transplantation
14
Renal 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
15
Renal Transplantation
de Boer, et al, Transpl Proc, 1999 31 2065
16
Renal Transplantation
de Boer, et al, Transpl Proc, 1999 31 2065
17
HTK vs UW KIDNEY Transplantation
  • N91 renal transplants HTK 50 UW 41
  • No differences in Delayed graft function
  • Graft survival
  • Patient survival

18
Creatinine 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)
20
HTK 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)

21
PANCREAS TRANSPLANTATION
22
Pancreas 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

23
Pancreas Transplantation
24
Pancreas 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

25
Pancreas Transplantation
26
Pancreas Transplantation
Primary preservation solution HTK, 2003 to 2007
27
Pancreas Islet Transplantation
28
Pancreas Islet Transplantation
29
LIVER TRANSPLANTATION
30
Liver Transplantation
  • N378 liver transplants HTK 174 UW 204

31
Liver Transplantation ECD

N698 liver transplants HTK 371 UW
327 Groups Standard 209 (30) ECD (old
age) 70 (10) ECD (physiologic stress) 435
(62)
32
Liver Transplantation ECD
33
Liver Transplantation ECD

N698 HTK 371 UW 327
34
Liver Transplantation ECD
Standard donors, n209
Extended criteria donors, n489
35
Liver Transplantation ECD
Donor 60 years, n70
Donor lt 60 years, n628
36
Liver Transplantation ECD
No physiologic stress, n263
Physiologic ECD, n435
37
Liver Transplantation ECD
38
Liver Transplantation
  • Biliary complications

39
Liver Transplantation
  • Biliary complications

40
Liver Transplantation
Donation after cardiac death, n43 HTK 35 UW
7
41
Liver Transplantation Recent

42
Intestinal / Multivisceral Transplantation
43
Intestinal 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
44
Intestinal Transplantation
45
Intestinal Transplantation
N57 intestinal transplants HTK 35 UW 22
46
Intestinal 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

47
CONCLUSIONS
  • 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

48
HTK 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
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