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Comparison of HTK and hypertonic citrate to intraarterial cooling in human non-heart-beating kidney donors

Lookup NU author(s): Professor Colin Wilson, John Asher, Dhakshina Vijayanand, Hugh Wyrley-Birch, Susan Stamp, David Rix, Professor Naeem Soomro, Professor Derek Manas, Bryon Jaques, David Talbot

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Abstract

Intraarterial cooling (IAC) of non-heart-beating donors (NHBD) for renal donation requires a cheap, low-viscosity solution. HTK contains a high hydrogen ion buffer level that theoretically should reduce the observable acidosis associated with ongoing anaerobic metabolism. A retrospective comparison of all retrieved NHBD kidneys as well as of viability on the Organ Recovery Systems Lifeporter machine perfusion circuit was performed with respect to the preservation solution HTK or Marshall's HOC. Forty-two NHBD kidneys (19 HTK and 23 HOC) were machine perfused between February 2004 and May 2005. Most of the HTK kidneys were obtained from uncontrolled donors (12 vs 5; Fisher exact test, P = .01). As a consequence, the glutathione-s-transferase viability assay (411 vs 292 IU/L, P = .12) and the lactate concentrations (2.33 vs 1.94 mmol/L, P = .13) were higher among the HTK cohort. There was evidence of greater buffering capacity in HTK, since the lactate:hydrogen ion ratios were consistently lower during the first 2 perfusion hours (1 hour P = .03, 2 hour P = .02). A linear regression analysis confirmed that this was related to the IAC solution (ANCOVA, P < .001). All controlled donor kidneys passed viability testing and were transplanted. In contrast, 83% (10/12) of the uncontrolled donor kidneys preserved with HTK passed the viability test and were transplanted, compared with only 20% (1/5) of the HOC-treated comparators (Fisher exact test, P = .03). It may be concluded that the postulated advantages of improved pH buffering with HTK appear to have clinical relevance. © 2007 Elsevier Inc. All rights reserved.

Publication metadata

Author(s): Wilson CH, Asher JF, Gupta A, Vijayanand DM, Wyrley-Birch H, Stamp S, Rix DA, Soomro NA, Manas DM, Jaques BC, Peaston R, Talbot D

Publication type: Article

Publication status: Published

Journal: Transplantation Proceedings

Year: 2007

Volume: 39

Issue: 2

Pages: 351-352

ISSN (print): 0041-1345

ISSN (electronic): 1873-2623

URL: http://dx.doi.org/10.1016/j.transproceed.2007.01.012

DOI: 10.1016/j.transproceed.2007.01.012

PubMed id: 17362727

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