Increased primary non-function in transplanted deceased-donor kidneys flushed with histidine-tryptophan-ketoglutarate...

Area of Science:

• Nephrology
• Transplantation Surgery
• Organ Preservation

Background:

• Histidine-Tryptophan-Ketoglutarate (HTK) solution is increasingly adopted for kidney preservation, with claimed efficacy comparable to the University of Wisconsin (UW) solution.
• Previous observations noted increased graft pancreatitis with HTK in pancreas transplants, prompting a review of its use in kidney transplantation.

Purpose of the Study:

• To evaluate the outcomes of deceased-donor kidney transplants preserved with HTK solution compared to UW solution.
• To identify factors influencing graft survival and renal function, specifically the impact of HTK solution.

Main Methods:

• Retrospective analysis of deceased-donor kidney transplant recipients (excluding pediatric and multi-organ) with at least 12 months follow-up.
• Comparison of patient survival, graft survival, rejection rates, and renal function between HTK and UW flushed kidneys.
• Cox regression analysis to identify predictors of early graft loss, including HTK solution use.

Main Results:

• No significant differences were observed in two-year patient survival, rejection rates, renal function, or overall graft survival between HTK and UW groups.
• HTK-flushed kidneys showed significantly worse early graft loss (<6 months), predominantly due to primary non-function (6.30% in HTK vs. 0.65% in UW, p=0.02).
• Early graft loss and delayed graft function associated with HTK solution were concentrated in lower-grade donor kidneys.

Conclusions:

• While long-term outcomes are similar, HTK solution use is an independent predictor of early graft loss in kidney transplantation, mainly from primary non-function.
• HTK solution should be used cautiously in marginal or lesser-grade donor kidneys due to increased risk of early graft failure.