Comparative analysis of clinical efficacy and cost between University of Wisconsin solution and histidine-tryptophan-ketoglutarate.

OBJECTIVE: To compare University of Wisconsin solution (Viaspan), the universal standard for organ preservation, with histidine-tryptophan-ketoglutarate solution. An analysis of each solution, in reference to clinical trials with specific organs, is presented and assessed to find the efficacy of each in a clinical environment. Also to view each solution from an economical standpoint, and in the end develop an overall understanding of the key similarities and differences between each solution in order to assess appropriate use of each in a clinical setting. DATA SOURCES: A literature search was conducted by using PubMed, MEDLINE, BIOSIS, Embase, and other online data bases to find the most recent studies of University of Wisconsin and histidine-tryptophan-ketoglutarate solutions. Search terms included University of Wisconsin solution, histidine-tryptophan-ketoglutarate, preservation solution, cost analysis, biliary complication, and other related subjects. STUDY SELECTION: Previous research was selected from the literature search to provide basic information on the 2 solutions and also to provide clinical examples of each solution and the efficacy of each with specific organs. DATA SYNTHESIS: Information and published articles on the 2 solutions were gathered for descriptive and comparative purposes. CONCLUSIONS: The 2 solutions appear equally effective in organ preservation. Each solution has its own organ-specific qualities, and each has different complications. The studies reviewed here indicate that the differences are minor and thus suggest that the 2 solutions are equally acceptable for clinical use. Of the 2 solutions, histidine-tryptophan-ketoglutarate costs less than University of Wisconsin solution.

Ex vivo evaluation of human lungs for transplant suitability.

BACKGROUND: If lungs could be retrieved from non-heart-beating donors, the critical shortage of lungs for transplant could be alleviated. An obstacle to this approach is the inability to predict these lungs' suitability for transplant. We used human lungs deemed unsuitable for transplant to develop a method to perfuse and ventilate human lungs ex vivo to assess gas exchange and vascular resistance, and to perform bronchoscopic inspection and radiographic evaluation. METHODS: Lungs were retrieved from six brain-dead organ donors after cold Perfadex (Vitrolife, Kungsbacka, Sweden) flush, stored cold for 6 to 13 hours (mean, 8.7 hours) then perfused and rewarmed in a modified cardiopulmonary bypass circuit. Circuit perfusate was buffered colloid-crystalloid containing type-specific leukocyte-filtered blood (hematocrit of 10%-12%), circulated through a membrane oxygenator ventilated with CO2 and nitrogen to deoxygenate it. Lungs were ventilated with fraction of inspired oxygen (Fio2) 0.5 when 32 degrees C was reached. Gas exchange and vascular resistance was assessed at 5 L/minute flow at 37 degrees C, Fio2 0.5 and 1.0. Bronchoscopy, plain radiographs, and spiral computed tomographic (CT) scans were performed. Lung biopsies were obtained pre- and post-reperfusion. RESULTS: Ex vivo perfusion did not cause increased wet to dry ratio, or major abnormalities by microscopy but was associated with elevated tissue levels of conjugated dienes. The alveolar-arterial difference in partial pressure of oxygen (Pao2)/Fio2 ratio in the ex vivo circuit was generally higher than in the six donors. Ex vivo radiographs and CT scans were abnormal in all lungs, confirming unsuitability of these lungs for transplant. CONCLUSIONS: Ex vivo evaluation of human lungs is feasible and may be useful to evaluate transplant suitability of lungs retrieved after circulatory arrest from non-heart-beating donors.