A propensity score matched analysis of liver transplantation outcomes in the setting of preservation solution shortage

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation Pub Date : 2023-11-07 DOI:10.1016/j.ajt.2023.10.028

William A. Preston , Devon J. Pace , Peter J. Altshuler , Misung Yi , Haley D. Kittle , Sage A. Vincent , Kenneth A. Andreoni , Adam M. Frank , Jaime M. Glorioso , Carlo G. Ramirez , Warren R. Maley , Ashesh P. Shah , Adam S. Bodzin

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引用次数: 0

Abstract

The recent shortage of the University of Wisconsin (UW) solution prompted increased utilization of histidine-tryptophan-ketoglutarate (HTK) solution for liver graft preservation. This contemporary study analyzed deceased donor liver transplant outcomes following preservation with HTK vs UW. Patients receiving deceased donor liver transplantations between January 1, 2019, and June 30, 2022, were retrospectively identified utilizing the Organ Procurement and Transplant Network database, stratified by preservation with HTK vs UW, and a propensity score matching analysis was performed. Outcomes assessed included rates of primary nonfunction, graft survival, and patient survival. There were 4447 patients in each cohort. Primary nonfunction occurred in 60 (1.35%) patients in the HTK group vs 25 (0.54%) in the UW group (P < .001). HTK was associated with lower 90-day graft survival (94.39% vs 96.09%; P < .001) and 90-day patient survival (95.97% vs 97.38%; P = .001). Unmatched donation after cardiac death-specific analysis of HTK vs UW demonstrated respective rates of primary nonfunction of 1.63% vs 0.82% (P = .20), 90-day graft survival of 92.50% vs 95.29% (P = .069), and 90-day patient survival of 93.90% vs 96.35% (P = .077). These results suggest that HTK may not be an equivalent preservation solution for deceased donor liver transplantation.

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保存液短缺情况下肝移植结果的倾向评分匹配分析。

威斯康星大学（UW）溶液最近的短缺促使组氨酸-色氨酸-酮戊二酸（HTK）溶液用于肝移植保存的利用率增加。这项当代研究分析了HTK与UW保存后死亡供体肝移植的结果。利用器官采购和移植网络数据库，对2019年1月1日至2022年6月30日期间接受已故供体肝移植的患者进行回顾性鉴定，根据HTK与UW的保存情况进行分层，并进行倾向评分匹配分析。评估的结果包括原发性无功能率、移植物存活率和患者存活率。每个队列中有4447名患者。HTK组有60名（1.35%）患者发生原发性无功能，而UW组有25名（0.54%）患者发生（p

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来源期刊

American Journal of Transplantation 医学-外科

CiteScore

18.70

自引率

4.50%

发文量

346

审稿时长

26 days

期刊介绍： The American Journal of Transplantation is a leading journal in the field of transplantation. It serves as a forum for debate and reassessment, an agent of change, and a major platform for promoting understanding, improving results, and advancing science. Published monthly, it provides an essential resource for researchers and clinicians worldwide. The journal publishes original articles, case reports, invited reviews, letters to the editor, critical reviews, news features, consensus documents, and guidelines over 12 issues a year. It covers all major subject areas in transplantation, including thoracic (heart, lung), abdominal (kidney, liver, pancreas, islets), tissue and stem cell transplantation, organ and tissue donation and preservation, tissue injury, repair, inflammation, and aging, histocompatibility, drugs and pharmacology, graft survival, and prevention of graft dysfunction and failure. It also explores ethical and social issues in the field.