Date: Tuesday, June 14, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
PURPOSE: To determine if LR, when used as the initial in situ aortic flush during DBD renal and hepatic procurement, was safe, effective, and non-inferior to either UW or HTK.
METHODS: UNOS data were queried as to 3 different in situ aortic flush solutions used during DBD organ procurement: LR, UW, and HTK; repeat and multi-organ txps were excluded. Data were analyzed from July 2004 to April 2012.
RESULTS: During this period, UNOS recorded 597 OLTs using LR as in situ flush, vs 26331 and 9546 using UW and HTK, respectively. All groups were similar in regard to most demographic variables. Cold ischemic time (CIT) was 8.0, 7.1 and 6.9 hrs for donors in the LR, UW, and HTK flush groups, respectively. There were no statistical differences in either 1 and 3 yr allograft or patient survival. Allograft failure within 7 days post-OLT was similar: 2.7%, vs 2.4 and 2.9% for LR, UW, and HTK groups. Allograft failure within 1 yr OLT due to biliary complications was less for the LR group (0.3%), vs the UW and HTK groups (0.7 and 0.6%). The need to re-list a recipient for any reason within 6 mos, 1 yr, or ever, was the same for each group.
In terms of renal txp data, 644 renal txps were performed using LR as the aortic in situ flush, vs 43375 and 15325 using UW and HTK, respectively. Terminal Cr was similar, but CIT was shorter in the LR group (13.6 hrs, vs 17.9 and 18.0 hrs, for LR, vs UW and HTK, respectively). 80% of LR kidneys were pumped, vs 31.0 and 33.1% for the UW and HTK groups, respectively. However, DGF rate for the LR group was 9.9%, vs 23.0 and 20.2 % for the UW and HTK groups, respectively. Adjusted regression modeling showed that the use of LR was significantly associated with lower odds of DGF (AOR=0.48, p<.0001). One and 3 yr allograft and patient survival were not statistically different between the donor flush groups.
During a single DBD procurement, from 6 to 8 L of UW or HTK will be used as the in situ aortic flush. If one compares this cost to that of LR, a savings of over $1500 can be realized.
CONCLUSIONS: Using LR as in situ aortic flush for DBD procurement leads to hepatic and renal transplant outcomes which were as good as standard (UW/HTK) flush. Cost savings for the OPO can be profound, with other, perhaps more important potential savings for txp centers and recipients, insofar as less DGF and biliary tract complications.
CITATION INFORMATION: Rudich S, Lange P. In Situ Aortic Flush with Lactated Ringer's (LR) Solution During Donation After Brain Death (DBD) Organ Procurement Provides Similar Outcomes and Significantly Decreases Costs in Kidney and Liver Transplantation Compared to Standard Preservation Solutions. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Rudich S, Lange P. In Situ Aortic Flush with Lactated Ringer's (LR) Solution During Donation After Brain Death (DBD) Organ Procurement Provides Similar Outcomes and Significantly Decreases Costs in Kidney and Liver Transplantation Compared to Standard Preservation Solutions. [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/in-situ-aortic-flush-with-lactated-ringers-lr-solution-during-donation-after-brain-death-dbd-organ-procurement-provides-similar-outcomes-and-significantly-decreases-costs-in-kidney-and-liver/. Accessed January 20, 2018.
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