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

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Presentation on theme: "Comparison of HTK and UW in Abdominal Transplantation Dr. Richard S. Mangus, MD MS Indiana University, School of Medicine."— Presentation transcript:

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 / donor3.5 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 2007Rank * Liver155Top 5 Pancreas841 st Kidney255Top 10 Small intestine22Top 5 OVERALL (+ thoracic) 562 Top 5 * www.unos.org, 2007 data reportwww.unos.org

10 Transplant Volume YearOrgans * 2001259 2002424 2003506 2004532 2005604 2006541 2007562

11 Transplant Volume YearOrgans * 2001259 2002424 2003506 2004532 2005604 2006541 2007562 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 Transplants: 1990 to 1992 DGF: Need for dialysis 2 or more times during first 7-days post-transplant Flush volume:HTK 5 – 6 L UW1 – 2 L EC4 L Renal Transplantation

15 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 N=91 renal transplantsHTK 50UW 41 No differences in:Delayed graft function Graft survival Patient survival

18 Creatinine Clearance Post Transplantation 0 20 40 60 80 100 123456710142130 time (days) ml/min UW HTK

19 Serum Creatinine Post Transplantation 0.0 2.0 4.0 6.0 8.0 10.0 12.0 036912151821242730 time (days) mg/dL UW HTK

20 HTK vs UW: Kidney Transplantation N=149 renal transplants > 16 hrsHTK 62, UW 87 No difference patient / graft survival HTK lower DGF (24% vs 56%, p<0.01) > 24 hrsHTK 31, UW 38 No difference in patient / graft survival HTK lower DGF (16% vs 56%, p<0.05)

21 PANCREAS TRANSPLANTATION

22 Pancreas Transplantation N= 20 pancreas transplantsHTK 10UW 10 No differences in:Graft survival Patient survival Serum fasting blood glucose Peak serum amylase Serial amylase levels

23 Pancreas Transplantation

24 N= 87pancreas transplantsHTK 78UW 9 No differences in:Graft survival Patient survival Serum fasting blood glucose Peak serum amylase Serial amylase levels

25 Pancreas Transplantation

26 Primary preservation solution: HTK, 2003 to 2007:

27 Pancreas Islet Transplantation

28

29 LIVER TRANSPLANTATION

30 Liver Transplantation N=378 liver transplantsHTK 174UW 204

31 Liver Transplantation: ECD N=698 liver transplantsHTK 371UW 327 Groups:Standard209 (30%) ECD (old age)70 (10%) ECD (physiologic stress)435 (62%)

32 Liver Transplantation: ECD

33 N=698HTK 371UW 327

34 Liver Transplantation: ECD Standard donors, n=209Extended criteria donors, n=489

35 Liver Transplantation: ECD Donor < 60 years, n=628 Donor ≥ 60 years, n=70

36 Liver Transplantation: ECD No physiologic stress, n=263 Physiologic ECD, n=435

37 Liver Transplantation: ECD

38 Liver Transplantation Biliary complications Elevated liver enzymes post- transplant Liver U/S with doppler Biliary imaging Liver biopsy

39 Liver Transplantation Biliary complications

40 Liver Transplantation Donation after cardiac death, n=43 HTK 35UW 7

41 Liver Transplantation: Recent

42 Intestinal / Multivisceral Transplantation

43 “Comparison of HTK and UW in Intestinal and Multivisceral Transplantation” - Mangus, et al. Transplantation, 2008; In Press Intestinal Transplantation N=57 intestinal transplantsHTK 35UW 22

44 Intestinal Transplantation

45 N=57 intestinal transplantsHTK 35UW 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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