David C. Mulligan, MD, FACS

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Presentation transcript:

Outcomes of Abdominal Organ Transplantation Using Custodial HTK Preservation Solution David C. Mulligan, MD, FACS Chair, Transplant, Hepatobiliary & Pancreatic Surgery Professor of Surgery, Mayo Clinic School of Medicine Mayo Clinic Arizona

Mayo Clinic Largest Transplant Entity in U.S. 1469 Total Transplants in 2006 717 446 306

Mayo Clinic Data 2007

MCA Abdominal Organ Transplant History Then and Now Liver Transplant Program Deceased Donor Liver Transplantation (1999) 2007 – 33rd out of 127 programs in US Living Donor Liver Program (2001) – 1st in AZ 2006 – 7th largest in the US 2007 – 5th largest out of 71 programs Kidney Transplant Program 2007 – 22nd largest out of 245 programs overall Living Donor Kidney Program (1999) 2006 – 15th largest in the US 2007 – 12th largest out of 245 programs Laparoscopic Donor Procedure (1999) First in the Foundation & Arizona Pancreas Transplant Program November 2002 UNOS Certified First K/P Transplant in July 2003 2007 – 3rd largest not factoring pancreas alone

MCA Liver Transplantation Program 1999 to 2007 Volume Data Liver Transplants - 411 Living Donor Transplants - 77 (19%) 2007 Volume Data Liver Transplants - 66 13 of 66 Transplants - Living Donor 2006 Outcome Data* 1 Year Patient Survival 91.85% Actual vs. 88.18% National Avg (Combined) 1 Year Graft Survival 89.41% Actual vs. 84.43% National Avg (Combined) * SRTR National Data Base - January 2007 Release

Mayo System and National Comparison % 1 Year Patient and Graft Survival SRTR National Data Base - January 2007 Release Deceased Donor Only for Appropriate Comparison

Mayo System and National Comparison Median Length of Stay Post Transplant SRTR National Data Base - January 2007 Release Median LOS for Deceased Donor

Liver Waitlist & Transplants 2001 - 2007 Wait List Size as of Last Day of Year

Etiology of Liver Disease * Liver disease transplanted Q1 2007 Q1 2007

Cold Ischemia Time (hours) Cumulative Average CIT 5.95 hrs Median CIT 5.75 hrs Range 1.5 -23 hrs Q1 2007

Benchmarking: National Centers of Excellence UNOS Patient Survival Data (1/01/04 - 6/30/06 w/ 1 Mo. & 1 Yr. Cohorts; 01/01/01 - 6/30/03 w/ 3 Yr. Cohort) Q4 2007

Benchmarking: National Centers of Excellence UNOS Graft Survival Data (1/01/04 - 6/30/06 w/ 1 Mo. & 1 Yr. Cohorts; 7/01/01 – 12/31/03 w/ 3 Yr. Cohort) Q4 2007

Kidney / Pancreas Transplant Program 2007

MCA Kidney Transplantation Program 1999 to 2007 Volume Data Kidney Transplants - 890 Living Donor Kidney Transplants - 455 (51%) Pancreas Transplants - 70 2007 Volume Data Kidney Transplants - 185 Living Donor Kidney Transplants - 88 (51%) Pancreas Transplants - 30 2006 Outcome Data Kidney Transplant* 1 Year Patient Survival 96.13% Actual vs. 96.47% Expected 1 Year Graft Survival 92.83% Actual vs. 93.34% Expected * SRTR National Data Base - January 2007 Release Combined Living and Deceased Donor Transplants

Mayo System and National Comparison % 1 Year Patient and Graft Survival * SRTR National Data Base - January 2007 Release Combined Living and Deceased Donor Transplants

Mayo System and National Comparison Length of Stay - Time on Wait List SRTR National Data Base - January 2007 Release LOS for Deceased Donor, Wait Times Includes Both Living and Deceased Donor Transplants

Kidney Waitlist & Transplants 2001 - 2007 Wait List Size as of Last Day of Year

Donor Source (N=654) Cumulative Living Related Donor 238 Living Unrelated Donor 154 Deceased Donor 262 Q1 2007

Pancreas Transplantation at MCA

Pancreas Transplants at MCA by type of transplant

Type of Surgical Procedure

MCH Patient/Graft Survival for KP Txs (Kaplan-Meier)

MCH Patient/Graft Survival for PAK & PTA (Kaplan-Meier)

Immunosuppression Thymoglobulin Prograf MMF Long-term steroids Campath Rapid steroid taper

Acute Rejection during the first year Kidney-Pancreas : 17% Solitary Pancreas: 32%

Kidney-Pancreas : Steroid Avoidance 37 patients Patient survival 100% Graft Survival Kidney 97% Pancreas 95% Acute Rejection 11%

Pancreas Experience with HTK (n=100) Mean CIT = 9.6hrs (4hrs – 22.9hrs) Less than 12hrs – 77% 12 to 15.9hrs – 18% Greater than 16hrs – 5% No cases of graft pancreatitis or vascular thrombosis due to preservation

Historical Total Transplant Volumes 2001 to present

Conclusions Strong clinical academic solid organ transplant practice with complete conversion from UW to Custodial HTK in 2003 without any negative effect Improved outcomes using Custodial for Living Donor Liver Transplantation Recommendation for HTK for DCD donors to improve outcomes