The impact of extended preservation on clinical liver transplantation

R. J. Stratta, R. P. Wood, Alan Norman Langnas, R. M. Duckworth, Rodney Smith Markin, W. Marujo, G. L. Grazi, S. Saito, I. Dawidson, L. F. Rikkers, T. J. Pillen, B. W. Shaw

Research output: Contribution to journalArticle

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Abstract

The introduction of UW solution into clinical transplantation has permitted extended cold storage preservation of the liver. Over a 46-month period, we have performed 308 orthotopic liver transplants (266 primary, 42 retransplants) in 266 recipients. Our experience is divided into cold-storage preservation in Euro- collins (163 transplants in 140 recipients) and UW (145 transplants in 131 recipients) solutions. Donor and recipient factors were comparable between the two groups. The use of UW solution has permitted an increase in the mean preservation time from 5.2±1.0 [EC] to 12.8±4.3 [UW] hr (P<0.00l). The mean total operating time was reduced but intraoperative blood loss was unchanged with UW preservation. The number of transplants performed during the daytime hours has increased dramatically (21.5% [EC] vs. 71% [UW], P<0.00l). The incidence of primary nonfunction, hepatic artery thrombosis, 1-month graft survival, and early retransplantation were similar in the 2 groups. Initial allograft function as determined by bile production, histology, and clinical assessment were likewise similar. Mean serum bilirubin, transaminase, and prothrombin levels were virtually identical by 5 days posttransplant. The enhanced margin of safety afforded by extended preservation has increased the capability for distant organ procurement and sharing, minimized organ wastage, and improved the efficiency of organ retrieval. With the relaxation of logistical constraints, our rate of liver import has nearly doubled (20.9% [EC] vs. 39.3% [UW], P<0.00l). Extended preservation has permitted the development of reduced-size liver grafting (n=12), resulting in a significant reduction in the number of deaths occurring while awaiting transplantation. Therefore, we advocate the use of UW solution with selective extension of preservation based not only on donor and recipient factors but also on manpower, resource, and logistical considerations.

Original languageEnglish (US)
Pages (from-to)438-443
Number of pages6
JournalTransplantation
Volume50
Issue number3
StatePublished - Jan 1 1990

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Liver Transplantation
Transplants
Liver
Transplantation
Tissue and Organ Harvesting
Tissue and Organ Procurement
Hepatic Artery
Prothrombin
Graft Survival
Transaminases
Bilirubin
Bile
Allografts
Histology
Thrombosis
Safety
Incidence
Serum
University of Wisconsin-lactobionate solution

ASJC Scopus subject areas

  • Medicine(all)
  • Transplantation

Cite this

Stratta, R. J., Wood, R. P., Langnas, A. N., Duckworth, R. M., Markin, R. S., Marujo, W., ... Shaw, B. W. (1990). The impact of extended preservation on clinical liver transplantation. Transplantation, 50(3), 438-443.

The impact of extended preservation on clinical liver transplantation. / Stratta, R. J.; Wood, R. P.; Langnas, Alan Norman; Duckworth, R. M.; Markin, Rodney Smith; Marujo, W.; Grazi, G. L.; Saito, S.; Dawidson, I.; Rikkers, L. F.; Pillen, T. J.; Shaw, B. W.

In: Transplantation, Vol. 50, No. 3, 01.01.1990, p. 438-443.

Research output: Contribution to journalArticle

Stratta, RJ, Wood, RP, Langnas, AN, Duckworth, RM, Markin, RS, Marujo, W, Grazi, GL, Saito, S, Dawidson, I, Rikkers, LF, Pillen, TJ & Shaw, BW 1990, 'The impact of extended preservation on clinical liver transplantation', Transplantation, vol. 50, no. 3, pp. 438-443.
Stratta RJ, Wood RP, Langnas AN, Duckworth RM, Markin RS, Marujo W et al. The impact of extended preservation on clinical liver transplantation. Transplantation. 1990 Jan 1;50(3):438-443.
Stratta, R. J. ; Wood, R. P. ; Langnas, Alan Norman ; Duckworth, R. M. ; Markin, Rodney Smith ; Marujo, W. ; Grazi, G. L. ; Saito, S. ; Dawidson, I. ; Rikkers, L. F. ; Pillen, T. J. ; Shaw, B. W. / The impact of extended preservation on clinical liver transplantation. In: Transplantation. 1990 ; Vol. 50, No. 3. pp. 438-443.
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abstract = "The introduction of UW solution into clinical transplantation has permitted extended cold storage preservation of the liver. Over a 46-month period, we have performed 308 orthotopic liver transplants (266 primary, 42 retransplants) in 266 recipients. Our experience is divided into cold-storage preservation in Euro- collins (163 transplants in 140 recipients) and UW (145 transplants in 131 recipients) solutions. Donor and recipient factors were comparable between the two groups. The use of UW solution has permitted an increase in the mean preservation time from 5.2±1.0 [EC] to 12.8±4.3 [UW] hr (P<0.00l). The mean total operating time was reduced but intraoperative blood loss was unchanged with UW preservation. The number of transplants performed during the daytime hours has increased dramatically (21.5{\%} [EC] vs. 71{\%} [UW], P<0.00l). The incidence of primary nonfunction, hepatic artery thrombosis, 1-month graft survival, and early retransplantation were similar in the 2 groups. Initial allograft function as determined by bile production, histology, and clinical assessment were likewise similar. Mean serum bilirubin, transaminase, and prothrombin levels were virtually identical by 5 days posttransplant. The enhanced margin of safety afforded by extended preservation has increased the capability for distant organ procurement and sharing, minimized organ wastage, and improved the efficiency of organ retrieval. With the relaxation of logistical constraints, our rate of liver import has nearly doubled (20.9{\%} [EC] vs. 39.3{\%} [UW], P<0.00l). Extended preservation has permitted the development of reduced-size liver grafting (n=12), resulting in a significant reduction in the number of deaths occurring while awaiting transplantation. Therefore, we advocate the use of UW solution with selective extension of preservation based not only on donor and recipient factors but also on manpower, resource, and logistical considerations.",
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AU - Grazi, G. L.

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