83 Histidine-tryptophan-ketoglutarate (HTK) is associated with higher post-reperfusion syndrome in deceased donor liver transplantation: Time for a global rethink?

Abstract Introduction With the increased use of marginal grafts and longer cold ischemia times (CIT), finding the optimal organ preservation solution is critical. Due to a shortage of University of Wisconsin (UW) solution, a temporary shift to histidine-tryptophan-ketoglutarate (HTK) solution for flushing and preserving deceased donor livers occurred in the UK. This pan-UK multicenter study aims to compare outcomes between liver grafts preserved with UW and HTK solutions. Methods This was a retrospective observational study of consecutive deceased donor liver transplants (DDLTs) performed in the UK between November 2022 and May 2023. Results Of the 478 deceased donor liver transplants (DDLTs), 224 used UW solution and 254 used HTK solution. Both groups were similar in donor and recipient demographics, graft type (DBD/DCD), CIT, warm ischemia time, and machine perfusion use. However, the HTK group had a higher incidence of post-reperfusion syndrome (PRS; drop in mean-arterial pressure >30% for >1 min within 5 mins of reperfusion) at 34.7% vs. 24.4% (p=0.014), with severe PRS twice as common (21.3% vs. 11.6%, p=0.004). Hospital stay was longer for the HTK group (15 vs. 14 days, p=0.019), with no differences in primary non-function, early allograft dysfunction, or 3-month graft and patient survival. HTK use was an independent predictor of PRS, while normothermic regional perfusion (NRP) during retrieval significantly reduced PRS (p=0.008). Conclusion HTK appears inferior to UW solution for graft preservation in DDLT. The global transplant community must urgently address the challenges of preservation solution shortages and their impact on achieving optimal outcomes.