RANDOMIZED TRIAL BETWEEN HISTIDINE-TRYPTOPHAN-KETOGLUTARATE [HTK] AND INSTITUTE OF GEORGE LOPEZ(IGL-1] PERFUSION SOLUTIONS IN LIVING DONOR LIVER TRANSPLANTATION
Sai T. Vasala*, Puneet Dhar, Sudhindran S, Sudheer OV, Johns S. Mathew
Surgical Gastroenterology, Amrita Institute Of Medical Sciences, Kochi, KErala, India
AIM: To compare early graft dysfunction in recipients of live donor liver grafts perfused with either HTK or IGL-1 solution on the bench
Materials and Methods: Over 9 months, 40 (32M:8 F) adult patients undergoing living donor liver transplantation (after excluding ABO incompatible transplants(n=3), pediatric liver transplants(n=5) and multivisceral transplants(n=1)), in a single institution, were randomized into two groups by computerized block randomization. Early graft dysfunction [EAD defined by Olthoff criteria[1] -bilirubin > or =10mg/dL on day 7, INR >or=1.6 on day 7, and alanine or aspartate aminotransferases >2000 IU/L within the first 7 days], peak bilirubin, peak INR, post operative transaminases, incidences of biliary complications, hepatic artery thrombosis[HAT], biopsy proven acute cellular rejections(ACR), 90 day mortality and graft survival within the first 6 months were compared between the two groups. Pre-transection and post reperfusion liver biopsies were taken.
Results: Both groups were equally matched in terms of base line characters and intraoperative parameters. There was no statistically significant difference in incidence of EAD between the two groups [IGL-1 - 3(15%) vs HTK - 5(25%),]. The peak transaminase level in the first week, was significantly lower in the IGL group. [peak AST: IGL-1 (median-222; range 73 - 1502) vs HTK (median - 465; range 108 - 3154) p = 0.034, peak ALT: IGL-1(median - 105, range 35-986) vs HTK (median - 190, range - 63-3672); p = 0.033]. There was no significant difference in incidences of acute cellular rejections, biliary complications, HAT, 90-day mortality and six month graft survival between the two groups. Pre-transection and postreperfusion biopsies were comparable between the two groups
Conclusions
Recipients of grafts perfused with IGL-1 had lower peak transaminase levels compared to HTK however there was no difference in EAD, biliary complications, rejections, mortality or graft survival between the two groups
Post operative peak transaminases
Intraoperative parameters
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