IGL-1 preservation solution and liver graft function, a retrospective study

N. Gilbo, J. Achtergaele, J. van den Eynde, I.J. Jochmans, M. Sainz-Bariga, D. Monbaliu, J. Pirenne

Friday 16 march 2018

10:10 - 10:15h at Willem Burger Foyer

Categories: Clinical, Session (poster)

Parallel session: Poster session 7: Clinical

Background

High risk organs are increasingly used for Liver Transplantation (LT), due to the shortage of pristine donors, but they are more sensitive to ischemia-reperfusion injury and carry increased rate of complications post-LT. Adequate preservation during cold storage is pivotal for the success of LT. We aim at investigating the effects of the recently introduced Institute George Lopez 1 preservation solution (IGL-1) on short-term outcomes compared to University of Wisconsin (UW) and Histidine-Tryptophan-Ketoglutarate (HTK) solutions.

Methods

After propensity score matching, 246 LT performed between 1/2000 – 1/2016 were considered. Donor, recipient demographic, transplant data, and short-term outcomes were compared between LT performed with IGL-1 (n=82), UW (n=82), or HTK (n=82) as preservation solutions. Bonferroni post-hoc correction for multiple testing was applied. A multivariable logistic regression assessed the effect of preservation solutions on Early Allograft Dysfunction (EAD), and was adjusted for the era effect. Data are expressed as median (IQR).

Results

Donor demographics was similar; however, donors after circulatory death were more frequently used in IGL-1 (47.6%) than in both UW (18.3%, p=0,02) and HTK (23.2%, p=0,04); and donor hepatectomy time was shorter in IGL-1 than in HTK [32min (23.5-41) vs. 39min (28.5-52), p=0.01]. Recipient demographics did not differ; however, none of the patients underwent LT due to acute liver failure in IGL-1, in contrast to both UW (2.4%, p<0.0001) and HTK (7.3%, p<0.0001). The duration of LT was longer for IGL-1 [6.57h (5.49-8.27)] than HTK [6h (4.49-6.74), p=0.0003] and UW [5.53h (4.43-6.92), p<0.0001]. Cold ischemia was shorter in IGL-1 [5.51h (4.51-8.17)] than in HTK [7.28h (5.83-8.55), p<0.001]. A peak AST>2000 IU/L within 7d post-LT occurred less frequently in IGL-1 (9.8%) than both UW (13.6%, p<0.0001) and HTK (24.4%, p<0.0001), but the incidence of Early Allograft Dysfunction (EAD) did not differ among groups. The rate of biliary strictures within 1y post-LT was similar. IGL-1 was the only solution protecting against EAD at univariate regression [OR:0.36, 95%CI:0.17-0.74, p=0.01], but this finding was not confirmed by multivariate analysis.

Conclusion

IGL-1 might better preserve liver grafts when compared to UW and HTK, but further investigations are needed.