Extended preservation of human liver grafts with UW solution

Abstract

The fate of 185 cadaveric liver homografts preserved for four to 24 hours with University of Wisconsin (UW) solution was compared with that of 180 grafts preserved for three to 9½ hours with conventional Euro-Collins solution.Although the average preservation time of the UW-preserved livers was almost twice as long as that of the Euro-Collins-preserved livers, the UW-preserved grafts survived at a higher rate; permitted equal patient survival; and had a lower rate of primary nonfunction, a reduced need for retransplantation, and a lower rate of hepatic artery thrombosis.There was no correlation between the time of preservation of UW-preserved grafts up to 24 hours and liver function abnormalities in the first postoperative week.In contrast, livers preserved with Euro-Collins solution for more than five hours had significantly increased perturbations of hepatic function tests.The potential revolutionary effect of the UW solution on liver transplantation is described herein.In September 1987, Jamieson and Kalayoglu and their associates1 , 2 at the University of Wisconsin (UW) reported that cold ischemia of canine and human liver homografts could be extended safely to one day with an infusate described by Wahlberg et al 3 in experiments on pancreas preservation.The superior qualities of their UW solution were confirmed in our laboratories with liver replacement experiments in dogs (S.Todo, L. Podesta, Y. Ueda, et al, unpublished data, Pittsburgh, Dec 15, 1988) and rats and with an isolated perfusion model in rats.4Herein, we report our experience with the first 185 human livers preserved with UW solution, with a minimum follow-up of three months after transplantation.The results were compared with those using 180 consecutive grafts that had been infused and preserved with Euro-Collins solution 5 during the immediately preceding five-month period. METHODS Recipient Case MaterialThere were 164 patients who received 185 UW-preserved livers between Oct 22, 1987, and March 21, 1988 (Table 1), 21 (12.2%)requiring retransplantation during the observation period of three to eight months.Of the 164 patients, 151 were undergoing primary transplantation.The other 13 had replacement of a graft transplanted in the pre-UW era months to years earlier.The 152 retrospective control patients received 180 Euro-Collins-preserved livers between May 22, 1987, and Oct 21, 1987; of these, 28 (18%) required retransplantation.Of these