Clinical effect of histidine-tryptophan-ketoglutarate solution <i>versus</i> University of Wisconsin solution for liver transplantation: a systematic review and meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HAN Caiwen ^1,2 , CHENG Mingxia ¹ , DONG Baolong ^1,2 , SI Moubo ² , YANG Jia ² , JIANG Wenjie ² , CAI Hui ² ,  HAO Xiangyong ² ,  GUO Tiankang ²

1. Department of Clinical Mediciine, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, P. R. China;
2. Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, P. R. China;

Corresponding author：

HAO Xiangyong, Email: haoxy-2008@163.com; GUO Tiankang, Email: tiankangguo2018@126.com

Keywords：

liver transplantation; UW solution; HTK solution; meta-analysis

DOI：

10.7507/1007-9424.201908088

Video：

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Objective To compare the clinical effects of two commonly used organ preservation solutions University of Wisconsin (UW) solution and histidine-tryptophan-ketoglutarate (HTK) solution in liver transplantation.Methods The PubMed, Embase, Cochrane Library, CNKI, CBM, VIP, and Wanfang Data were searched to collect the comparative studies of the UW solution and HTK solution in the liver transplantation. The data were extracted and evaluated by the RevMan 5.3 software.Results Finally, 16 articles with a total of 35 024 patients were included. The meta-analysis results showed that the HTK solution group had a lower incidence of postoperative biliary complications [RR=1.30, 95%CI (1.07 1.58), P=0.008] and lower aspartate aminotransferase peak level within 7 d after operation [MD=112.45, 95%CI (93.34, 131.56), P<0.01] as compared with the UW solution group. No significant differences were found in terms of the incidence of primary non-function [RR=1.07, 95%CI (0.52, 2.18), P=0.86], survival rates of patient and graft in different time points (P>0.05), incidence of retransplantation [RR=0.83, 95%CI (0.48, 1.45), P=0.51], incidence of acute rejection [RR=1.27, 95%CI (0.96, 1.68), P=0.33], alanine aminotransferase peak level within 7 d [MD=31.79, 95%CI (–161.84, 225.42), P=0.75] after operation, total bilirubin [MD=19.42, 95%CI (–10.83, 49.67), P=0.21], and prothrombin time [MD=1.75, 95%CI (0.01, 3.49), P=0.84] between these two groups.Conclusions HTK solution is safe and effective for liver transplantation, and has similar effects as UW solution. Regarding effect of both on long-term survival rates of patient and graft, large-sample and high-quality RCT is still needed for systematic evaluation.

Citation： HAN Caiwen, CHENG Mingxia, DONG Baolong, SI Moubo, YANG Jia, JIANG Wenjie, CAI Hui, HAO Xiangyong, GUO Tiankang. Clinical effect of histidine-tryptophan-ketoglutarate solution versus University of Wisconsin solution for liver transplantation: a systematic review and meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(5): 579-587. doi: 10.7507/1007-9424.201908088 Copy

1.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin, 2019, 69(1): 7-34.
2.	Chang L, Wang Y, Zhang J, et al. The best strategy for HCC patients at each BCLC stage: a network meta-analysis of observational studies. Oncotarget, 2017, 8(12): 20418-20427.
3.	严律南. 中国大陆活体肝移植的现状及展望. 中国普外基础与临床杂志, 2018, 25(8): 897-899.
4.	Burra P, Zanetto A, Russo FP, et al. Organ preservation in liver transplantation. Semin Liver Dis, 2018, 38(3): 260-269.
5.	Voigt MR, DeLario GT. Perspectives on abdominal organ preservation solutions: a comparative literature review. Prog Transplant, 2013, 23(4): 383-391.
6.	Stewart ZA. UW solution: still the “gold standard” for liver transplantation. Am J Transplant, 2015, 15(2): 295-296.
7.	Erhard J, Lange R, Scherer R, et al. Comparison of histidine-tryptophan-ketoglutarate (HTK) solution versus University of Wisconsin (UW) solution for organ preservation in human liver transplantation. A prospective, randomized study. Transpl Int, 1994, 7(3): 177-181.
8.	Meine MH, Zanotelli ML, Neumann J, et al. Randomized clinical assay for hepatic grafts preservation with University of Wisconsin or histidine-tryptophan-ketoglutarate solutions in liver transplantion. Transplant Proc, 2006, 38(6): 1872-1875.
9.	Canelo R, Hakim NS, Ringe B. Experience with hystidine tryptophan ketoglutarate versus University Wisconsin preservation solutions in transplantation. Int Surg, 2003, 88(3): 145-151.
10.	Testa G, Malagó M, Nadalin S, et al. Histidine-tryptophan-ketoglutarate versus University of Wisconsin solution in living donor liver transplantation: results of a prospective study. Liver Transpl, 2003, 9(8): 822-826.
11.	Avolio AW, Agnes S, Nure E, et al. Comparative evaluation of two perfusion solutions for liver preservation and transplantation. Transplant Proc, 2006, 38(4): 1066-1067.
12.	Mangus RS, Tector AJ, Agarwal A, et al. Comparison of histidine-tryptophan-ketoglutarate solution (HTK) and University of Wisconsin solution (UW) in adult liver transplantation. Liver Transpl, 2006, 12(2): 226-230.
13.	Rayya F, Harms J, Martin AP, et al. Comparison of histidine-tryptophan-ketoglutarate solution and University of Wisconsin solution in adult liver transplantation. Transplant Proc, 2008, 40(4): 891-894.
14.	Adam R, Delvart V, Karam V, et al. Compared efficacy of preservation solutions in liver transplantation: a long-term graft outcome study from the European Liver Transplant Registry. Am J Transplant, 2015, 15(2): 395-406.
15.	Stewart ZA, Cameron AM, Singer AL, et al. Histidine-Tryptophan-Ketoglutarate (HTK) is associated with reduced graft survival in deceased donor livers, especially those donated after cardiac death. Am J Transplant, 2009, 9(2): 286-293.
16.	Feng L, Zhao N, Yao X, et al. Histidine-tryptophan-ketoglutarate solution vs. University of Wisconsin solution for liver transplantation: A systematic review. Liver Transpl, 2007, 13(8): 1125-1136.
17.	沙地克·阿帕尔, 吐尔洪江·吐逊, 李玉鹏, 等. UW和HTK器官保存液对移植供肝保存效果及术后结局影响的meta分析. 中华消化外科杂志, 2016, 15(5): 482-489.
18.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
19.	Wells G, Shea B, Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta analysis. (2012-04-26) [2019-02-20]. http://www.o-hri.ca/programs/clinical_epidemiology/oxford.asp.
20.	Kinoshita K, Ikai I, Gomi T, et al. Exposure of hepatic sinusoidal mononuclear cells to UW solution in situ but not ex vivo induces apoptosis. J Hepatol, 1998, 29(2): 300-305.
21.	Hatano E, Kiuchi T, Tanaka A, et al. Hepatic preservation with histidine-tryptophan-ketoglutarate solution in living-related and cadaveric liver transplantation. Clin Sci (Lond), 1997, 93(1): 81-88.
22.	Chan SC, Liu CL, Lo CM, et al. Applicability of histidine-tryptophan-ketoglutarate solution in right lobe adult-to-adult live donor liver transplantation. Liver Transpl, 2004, 10(11): 1415-1421.
23.	Jain A, Mohanka R, Orloff M, et al. University of Wisconsin versus histidine-tryptophan-ketoglutarate for tissue preservation in live-donor liver transplantation. Exp Clin Transplant, 2006, 4(1): 451-457.
24.	Moench C, Otto G. Ischemic type biliary lesions in histidine-tryptophan-ketoglutarate (HTK) preserved liver grafts. Int J Artif Organs, 2006, 29(3): 329-334.
25.	Moray G, Sevmis S, Karakayali FY, et al. Comparison of histidine-tryptophan-ketoglutarate and University of Wisconsin in living-donor liver transplantation. Transplant Proc, 2006, 38(10): 3572-3575.
26.	郑卫萍, 沈中阳, 朱志军, 等. 肝移植3种器官保存液的比较研究. 中国现代医学杂志, 2008, 18(18): 2704-2708.
27.	Mangus RS, Schroering JR, Hathaway TJ, et al. Comparison of Histidine-Tryptophan-Ketoglutarate and University of Wisconsin preservation solutions in pediatric liver transplantation. Pediatr Transplant, 2018, 15: e13252.
28.	Chedid MF, Pinto MA, Juchem JFG, et al. Liver preservation prior to transplantation: Past, present, and future. World J Gastrointest Surg, 2019, 11(3): 122-125.
29.	Oh CK, Sawyer RG, Pelletier SJ, et al. Independent predictors for primary non-function after liver transplantation. Yonsei Med J, 2004, 45(6): 1155-1161.
30.	Salviano MEM, Lima AS, Tonelli IS, et al. Primary liver graft dysfunction and non-function: integrative literature review. Rev Col Bras Cir, 2019, 46(1): e2039.
31.	Moreno C, Sabaté A, Figueras J, et al. Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft. Liver Transpl, 2006, 12(11): 1607-1614.
32.	王正昕, 钦伦秀. 肝移植术后并发症的防治现状及进展. 中国普外基础与临床杂志, 2018, 25(9): 1025-1030.
33.	蒙建源, 徐静, 樊奇, 等. 肝移植术后胆道并发症危险因素的Meta分析. 中华肝胆外科杂志, 2012, 18(11): 816-822.
34.	Heidenhain C, Pratschke J, Puhl G, et al. Incidence of and risk factors for ischemic-type biliary lesions following orthotopic liver transplantation. Transpl Int, 2010, 23(1): 14-22.
35.	León Díaz FJ, Fernández Aguilar JL, Nicolás de Cabo S, et al. Combined flush with Histidine-Tryptophan-Ketoglutarate and University of Wisconsin Solutions in liver transplantation: preliminary results. Transplant Proc, 2018, 50(2): 539-542.
36.	Stewart ZA, Lonze BE, Warren DS, et al. Histidine-tryptophan-ketoglutarate (HTK) is associated with reduced graft survival of deceased donor kidney transplants. Am J Transplant, 2009, 9(5): 1048-1054.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin, 2019, 69(1): 7-34.
2. Chang L, Wang Y, Zhang J, et al. The best strategy for HCC patients at each BCLC stage: a network meta-analysis of observational studies. Oncotarget, 2017, 8(12): 20418-20427.
3. 严律南. 中国大陆活体肝移植的现状及展望. 中国普外基础与临床杂志, 2018, 25(8): 897-899.
4. Burra P, Zanetto A, Russo FP, et al. Organ preservation in liver transplantation. Semin Liver Dis, 2018, 38(3): 260-269.
5. Voigt MR, DeLario GT. Perspectives on abdominal organ preservation solutions: a comparative literature review. Prog Transplant, 2013, 23(4): 383-391.
6. Stewart ZA. UW solution: still the “gold standard” for liver transplantation. Am J Transplant, 2015, 15(2): 295-296.
7. Erhard J, Lange R, Scherer R, et al. Comparison of histidine-tryptophan-ketoglutarate (HTK) solution versus University of Wisconsin (UW) solution for organ preservation in human liver transplantation. A prospective, randomized study. Transpl Int, 1994, 7(3): 177-181.
8. Meine MH, Zanotelli ML, Neumann J, et al. Randomized clinical assay for hepatic grafts preservation with University of Wisconsin or histidine-tryptophan-ketoglutarate solutions in liver transplantion. Transplant Proc, 2006, 38(6): 1872-1875.
9. Canelo R, Hakim NS, Ringe B. Experience with hystidine tryptophan ketoglutarate versus University Wisconsin preservation solutions in transplantation. Int Surg, 2003, 88(3): 145-151.
10. Testa G, Malagó M, Nadalin S, et al. Histidine-tryptophan-ketoglutarate versus University of Wisconsin solution in living donor liver transplantation: results of a prospective study. Liver Transpl, 2003, 9(8): 822-826.
11. Avolio AW, Agnes S, Nure E, et al. Comparative evaluation of two perfusion solutions for liver preservation and transplantation. Transplant Proc, 2006, 38(4): 1066-1067.
12. Mangus RS, Tector AJ, Agarwal A, et al. Comparison of histidine-tryptophan-ketoglutarate solution (HTK) and University of Wisconsin solution (UW) in adult liver transplantation. Liver Transpl, 2006, 12(2): 226-230.
13. Rayya F, Harms J, Martin AP, et al. Comparison of histidine-tryptophan-ketoglutarate solution and University of Wisconsin solution in adult liver transplantation. Transplant Proc, 2008, 40(4): 891-894.
14. Adam R, Delvart V, Karam V, et al. Compared efficacy of preservation solutions in liver transplantation: a long-term graft outcome study from the European Liver Transplant Registry. Am J Transplant, 2015, 15(2): 395-406.
15. Stewart ZA, Cameron AM, Singer AL, et al. Histidine-Tryptophan-Ketoglutarate (HTK) is associated with reduced graft survival in deceased donor livers, especially those donated after cardiac death. Am J Transplant, 2009, 9(2): 286-293.
16. Feng L, Zhao N, Yao X, et al. Histidine-tryptophan-ketoglutarate solution vs. University of Wisconsin solution for liver transplantation: A systematic review. Liver Transpl, 2007, 13(8): 1125-1136.
17. 沙地克·阿帕尔, 吐尔洪江·吐逊, 李玉鹏, 等. UW和HTK器官保存液对移植供肝保存效果及术后结局影响的meta分析. 中华消化外科杂志, 2016, 15(5): 482-489.
18. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
19. Wells G, Shea B, Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta analysis. (2012-04-26) [2019-02-20]. http://www.o-hri.ca/programs/clinical_epidemiology/oxford.asp.
20. Kinoshita K, Ikai I, Gomi T, et al. Exposure of hepatic sinusoidal mononuclear cells to UW solution in situ but not ex vivo induces apoptosis. J Hepatol, 1998, 29(2): 300-305.
21. Hatano E, Kiuchi T, Tanaka A, et al. Hepatic preservation with histidine-tryptophan-ketoglutarate solution in living-related and cadaveric liver transplantation. Clin Sci (Lond), 1997, 93(1): 81-88.
22. Chan SC, Liu CL, Lo CM, et al. Applicability of histidine-tryptophan-ketoglutarate solution in right lobe adult-to-adult live donor liver transplantation. Liver Transpl, 2004, 10(11): 1415-1421.
23. Jain A, Mohanka R, Orloff M, et al. University of Wisconsin versus histidine-tryptophan-ketoglutarate for tissue preservation in live-donor liver transplantation. Exp Clin Transplant, 2006, 4(1): 451-457.
24. Moench C, Otto G. Ischemic type biliary lesions in histidine-tryptophan-ketoglutarate (HTK) preserved liver grafts. Int J Artif Organs, 2006, 29(3): 329-334.
25. Moray G, Sevmis S, Karakayali FY, et al. Comparison of histidine-tryptophan-ketoglutarate and University of Wisconsin in living-donor liver transplantation. Transplant Proc, 2006, 38(10): 3572-3575.
26. 郑卫萍, 沈中阳, 朱志军, 等. 肝移植3种器官保存液的比较研究. 中国现代医学杂志, 2008, 18(18): 2704-2708.
27. Mangus RS, Schroering JR, Hathaway TJ, et al. Comparison of Histidine-Tryptophan-Ketoglutarate and University of Wisconsin preservation solutions in pediatric liver transplantation. Pediatr Transplant, 2018, 15: e13252.
28. Chedid MF, Pinto MA, Juchem JFG, et al. Liver preservation prior to transplantation: Past, present, and future. World J Gastrointest Surg, 2019, 11(3): 122-125.
29. Oh CK, Sawyer RG, Pelletier SJ, et al. Independent predictors for primary non-function after liver transplantation. Yonsei Med J, 2004, 45(6): 1155-1161.
30. Salviano MEM, Lima AS, Tonelli IS, et al. Primary liver graft dysfunction and non-function: integrative literature review. Rev Col Bras Cir, 2019, 46(1): e2039.
31. Moreno C, Sabaté A, Figueras J, et al. Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft. Liver Transpl, 2006, 12(11): 1607-1614.
32. 王正昕, 钦伦秀. 肝移植术后并发症的防治现状及进展. 中国普外基础与临床杂志, 2018, 25(9): 1025-1030.
33. 蒙建源, 徐静, 樊奇, 等. 肝移植术后胆道并发症危险因素的Meta分析. 中华肝胆外科杂志, 2012, 18(11): 816-822.
34. Heidenhain C, Pratschke J, Puhl G, et al. Incidence of and risk factors for ischemic-type biliary lesions following orthotopic liver transplantation. Transpl Int, 2010, 23(1): 14-22.
35. León Díaz FJ, Fernández Aguilar JL, Nicolás de Cabo S, et al. Combined flush with Histidine-Tryptophan-Ketoglutarate and University of Wisconsin Solutions in liver transplantation: preliminary results. Transplant Proc, 2018, 50(2): 539-542.
36. Stewart ZA, Lonze BE, Warren DS, et al. Histidine-tryptophan-ketoglutarate (HTK) is associated with reduced graft survival of deceased donor kidney transplants. Am J Transplant, 2009, 9(5): 1048-1054.

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Clinical effect of histidine-tryptophan-ketoglutarate solution versus University of Wisconsin solution for liver transplantation: a systematic review and meta-analysis

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