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The Effect of Histidine-tryptophan-ketoglutarate Solution and University of Wisconsin Solution: An Analysis of the Eurotransplant Registry

de Boer, Jacob D., MD1,2; Strelniece, Agita3; van Rosmalen, Marieke, MD1; de Vries, Erwin1; Ysebaert, Dirk, MD, PhD4; Guba, Markus, MD, PhD5; Braat, Andries Erik, MD, PhD2; Samuel, Undine, MD, PhD1

doi: 10.1097/TP.0000000000002406
Original Clinical Science—Liver

Background Both University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are currently used in the Eurotransplant region for preservation of liver allografts. Previous studies on their effect have led to a lot of discussion. This study aims to compare the effect of HTK and UW on graft survival.

Methods First liver transplantations in recipients 18 years or older from January 1, 2007, until December 31, 2016, were included. Graft survival was compared for livers preserved with HTK and UW at 30 days, 1, 3, and 5 years. Multivariable analysis of risk factors was performed and outcome was adjusted for important confounders.

Results Of all 10 628 first liver transplantations, 8176 (77%) and 2452 (23%) were performed with livers preserved with HTK and UW, respectively. Kaplan-Meier curves showed significant differences in graft survival between HTK and UW at 30 days (89% vs 93%, P=<0.001), 1 year (75% vs 82%, P=<0.001), 3 years (67% vs 72%, P<0.001), and at 5 years (60% vs 67%, P<0.001). No significant differences in outcome were observed in separate analyses of Germany or non-German countries. In multivariable analysis, UW was associated with a decreased risk of graft loss at 30 days (HR 0.772, P=0.002) and at 1 year (0.847 (0.757-0.947). When adjusted for risk factors, no differences in long term outcome could be detected.

Conclusions Because the use of preservation fluids is clustered geographically, differences in outcome by preservation fluids are strongly affected by regional differences in donor and recipient characteristics. When adjusted for risk factors, no differences in graft survival exist between transplantations performed with livers preserved with either HTK or UW.

The real-world relative effectiveness of UW and HTK remains difficult to discern. When adjusted for regional differences in the Eurotransplant registry, no outcome differences between the two solutions were identified.

1 Eurotransplant International Foundation, Leiden, The Netherlands.

2 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.

3 Biostatistical Department, Eurotransplant International Foundation, Leiden, The Netherlands.

4 Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, University of Antwerp, Belgium.

5 Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Munich, Germany.

Received 22 February 2018. Revision received 18 May 2018.

Accepted 29 May 2018.

The authors declare no funding or conflict of interest.

Jd.B. and U.S. participated in the study concept and design. Mv.R. and E.V. participated in the acquisition of data. Jd.B., A.S. participated in the statistical analysis. Jd.B., A.S., E.V., A.B. participated in the analysis and interpretation of data. Jd.B., U.S., Mv.R., A.B. participated in the drafting of the article. M.G., A.B., U.S., D.Y., Mv.R., E.V. participated in the critical revision of the article. A.S., U.S. participated in the study supervision.

On behalf of the Eurotransplant Liver and Intestine Advisory Committee (ELIAC) and Organ Procurement Process Chain Committee (OPCC).

Correspondence: J.D. de Boer, MD, Eurotransplant International Foundation, Leiden, The Netherlands. (

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