Inferior outcome of cadaveric kidneys preserved for more than 24 hr in histidine-tryptophan-ketoglutavate solution

Background During recent years, an increasing number of transplant centers within the Eurotransplant organization have used histidine-tryptophan-ketog lutarate (HTK) solution instead of University of Wisconsin (UW) solution as their preferred cold storage solution for abdominal organ preservation, We report on our single-center experience on the outcome of imported kidneys preserved with either HTK or UW solution in relation to the duration of col d ischemia time (CIT). Methods. Between July 1989 and July 1997, 323 cadaveric kidneys preserved w ith UW or HTK and imported as a result of an exchange within the Eurotransp lant organization were transplanted at our institution. CIT was <24 hr in 2 16 kidneys (UW: n=174, HTR: n=42) and greater than or equal to 24 hr in 107 kidneys (UW: n=67, HTK: n=40). Renal functional outcome was evaluated by c omparing delayed graft function and initial nonfunction rates, daily urinar y output, the evolution of serum creatinine, and creatinine clearance at 1, 3, 5, 7, and 14 days and at 1, 3, 6 and 12 months, and graft survival at 1 year after transplantation in relation to the type of cold storage solutio n and CIT < or greater than or equal to 24 hr. Results. Whereas the incidence of delayed graft function did not differ sig nificantly between kidneys preserved for less than 24 hr in UW (18.6%) or H TK (26.2%), this rate increased to 50% in HTK kidneys compared to 23.9% in UW kidneys when CIT exceeded 24 hr (P=0.006), Mean serum creatinine and cre atinine clearance values were better at 1 and 5 days postoperatively in kid neys preserved <24 hr with UW as compared to HTR (P<0.05). After 24 hr of C IT, HTK-preserved kidneys showed an impaired renal function, not only in th e immediate postoperative phase but also at 1, 3, 6, and 12 months after tr ansplantation (P<0.05). Graft survival at 1 year was 92.9% in UW vs. 87.5% in HTK kidneys preserved for <24 hr (NS), and 91% vs. 77.4% when CIT exceed ed 24 hr (P=0.059). Conclusions. From these single-center findings, it can be concluded that UW is superior to HTK in kidney preservation, particularly when CIT exceeds 2 4 hr.