The influence of an improved preservation solution On prognostic factors for graft survival in pediatric liver transplantation

We investigated the influence of Eurocollins (EC) and University of Wisconson solution (UW) on prognostic factors for graft survival after pediatric liver transplantation. The 1-year graft survival was studied for 30 patients in which 38 transplantations were performed between 1982 and 1988. We preserved 19 grafts in EC and the other 19 grafts in UW solution. For grafts preserved in EC, the median preservation time was 5 h compared to 10.8 h for grafts preserved in UW solution (P < 0.01). Graft survival at 1 year was equivalent in both groups (63%). No significant differences were observed between the two groups for the following variables: patient diagnosis, child-pugh score, age, operative time, anhepatic phase, blood loss, morbidity, ICU stay, donor age and graft survival. Multivariate analysis indicated that in the EC group anhepatic phase, blood loss and preservation time were significant predictors of graft survival whereas in the UW group, none of these factors appeared to be significant. We concluded that UW was superior to EC solution in pediatric liver transplantations because it allowed longer preservation times, the length of the anhepatic phase was less important and the tolerance for blood loss seemed to be extended.     

Improved heart and lung preservation in a rat model

We investigated the efficacy of four different preservation solutions in a heart-lung model in the rat. The heart and lungs of the donor were perfused under standardised conditions of temperature, pressure and flow. We studied 4 groups: group 1 received Stanford solution to heart and lung; group 2 received St. Thomas' solution to heart and Papworth solution to lung; group 3 received University of Wisconsin solution to heart and lung; and group 4 received University of Wisconsin solution to heart and Papworth solution to lung. Lung function assessed by arterial pO₂ at a standardised F₁O₂ was significantly better in groups 2 and 4 than in other groups. However, cardiac function as assessed by cardiac output, stroke work index and minute work index was significantly better in group 4 than in any other group. Overall, the combination of solutions in group 4 provided the most effective preservation in this model.     

Microcirculatory disturbances and leucocyte adherence in transplanted livers after cold storage in Euro-Collins,UW and HTK solutions

Integrity of the hepatic microcirculation and maintenance of endothelial cell viability are critical components in preventing primary non-function after liver transplantation. Therefore, hepatic microcirculation and leucocyte-endothelial interaction were studied in rat livers stored for 1 h in Euro-Collins (EC), University of Wisconsin (UW), and histidine-tryptophan-ketoglutarate (HTK) solutions and subsequently transplanted. One hour after transplantation surgery, the livers were exposed under an intravital fluorescence microscope. After injection of the leucocyte marker acridine orange (1 mol/kg), six pericentral fields were observed for 30 s and experiments were recorded continuously. The percentage of perfused sinusoids was reduced in the livers in the EC group (82.9%) in contrast to the UW (93.2%) and HTK groups (91.0%). Livers in the EC group showed a reduction in the diameters of pericentral sinusoids (7.3±0.2 m; mean±SEM) compared with the UW group (9.5±0.2 m; P<0.05) and HTK group (10.2±0.8 m; P<0.05), indicating substantial cell swelling in livers stored in EC solution. Permanent adherence of leucocytes was most frequently observed in the EC group (33.5±1%), while this phenomenon was less pronounced in the UW group (14.5+1.1%; P<0.05) and HTK group (16.3±0.7%; P<0.05). Conversely, temporary adherence of leucocytes was reduced in the EC group (19.7+1.3%) compared with the UW group (30.5+2.1%) and the HTK group (34.4+0.8%). Microcirculatory failure and cell swelling in the EC group might be due to the lack of osmotic substances or oxygen radical scavengers included in UW (allopurinol, glutathione) and HTK (mannitol) solutions. In conclusion, cold storage of livers in UW and HTK solutions results in better preservation of the microcirculation and prevention of adhesion of leucocytes after transplantation compared with the EC solution.     

Impact of dysphagia on quality-of-life in nasopharyngeal carcinoma

BACKGROUND: Little is known about dysphagia or quality of life (QOL) in patients treated for nasopharyngeal carcinoma (NPC). The aim of this study was to determine the impact of dysphagia on QOL in patients treated for NPC as measured by two standard tools, the University of Washington Quality-of-Life Questionnaire(1) (UW-QOL) and the Swallow Quality-of-Life Questionnaire(3) (SWAL-QOL). METHODS: This is a cross-sectional survey of 59 consecutive disease-free survivors of NPC attending the head and neck cancer clinic at the National University Hospital, Singapore. The UW-QOL and SWAL-QOL underwent minor modification and were translated into Mandarin. A linear regression analysis was performed to identify significant predictors of health-related QOL. RESULTS: Fifty-one patients (86%) responded; of these, 43 had self-reported swallowing difficulties. On the UW-QOL, respondents indicated the three most important issues to be swallowing (59%), hearing (45%), and saliva/dry mouth (41%). Respondents with swallowing difficulty reported a lower UW-QOL composite score (p = .002) and a lower health-related QOL score (HR-QOL) than those without swallowing difficulty (p = .004). Self-reported swallowing difficulty predicted a lower HR-QOL score (p = .004). A longer time since treatment predicted a better score in HR-QOL (p = .024). A lower score in fatigue predicted a lower HR-QOL score (p = .001). CONCLUSIONS: Swallowing difficulties negatively impact QOL. It is recommended that future QOL studies aimed specifically at swallowing function in NPC use a swallowing specific questionnaire (eg, SWAL-QOL) in addition to a head and neck-specific measure. Further research is needed to look at the adaptation and usefulness of swallowing-specific QOL surveys for use with people treated for NPC.     

SX-1液对肝脏保存效果的实验研究

目的 应用改良后的Kamada二袖套法大鼠原位肝移植模型,检验SX-1液、HC-A液和UW液对肝脏保存的效果.方法 在无菌条件下配制肝脏保存液.建立大鼠原位肝移植模型.使用SX-1液、UW液和HC-A液保存大鼠肝脏2、8、24 h后行大鼠原位肝移植,于移植后6 h比较各项肝脏功能.结果 对于ALT、AST,SX-1液组(2、8、24 h)与UW液组同步升高,分析无统计学意义(P＞0.05),与HC-A液组相比,差异有统计学意义(P＜0.05).对于LDH,SX-1液组(2 h、8 h、24 h)与HC-A液组同步升高,差异无统计学意义(P＞0.05),与UW液组相比,差异有统计学意义(P＜0.05).对于分泌胆汁的肝脏个数,各组别与分泌胆汁的肝脏个数无差别(P＞0.05).本组内各时间点分泌胆汁个数有差别(P＜0.05).随肝脏保存时间增长,分泌胆汁的肝脏个数减少.结论 经大鼠原位肝移植模型证实,SX-1液在肝脏酶学方面与UW液作用相当,超过HC-A液水平.肝移植后6 h肝脏分泌胆汁的个数方面,SX-1液与HC-A液、UW液间无明显差别.     

HTK液,UW液,St.Thomas Ⅱ液对离体鼠心低温保存的形态学观察

目的 :研究在冷缺血期三种液体对鼠心保存的效果。方法 :将离体鼠心分别用HTK液 ,UW液及St.ThomasⅡ液灌停并4℃冷冻保存 6h。利用离体鼠心非循环式Langendorff灌流功能测定模型。复灌 1h后 ,取心肌组织做光镜电镜观察。结果 :经过HTK液保存后的鼠心细胞损伤较轻 ,UW液鼠心细胞损伤较重 ,但冠脉血管内膜剥脱较重。St.ThomasⅡ液鼠心细胞损伤最重。结论 :HTK液心肌保存效果最好。高钾对血管内皮有损害     

Limited Survival of Rat Small Bowel Transplants Preserved in University of Wisconsin Solution for 48 Hours

We have previously shown that rat small bowel may successfully be transplanted after preservation for 24 hours. In this study, syngeneic rat small bowel transplants were studied by light microscopy and transmission electron microscopy during and after preservation in University of Wisconsin (UW) solution for 48 hours. A total of 6 transplants were carried out using a previously described, standardized technique. In most cases, the bowel appeared histologically well preserved at the end of the 48 hr storage period (prior to implantation). Upon revascularization, however, reperfusion injury was dramatic, with loss of villi and crypts and inflammatory cells in all layers. The bowel was abnormal grossly as well as microscopically. This injury was irreversible with persistently abnormal histology for up to 1 week in all but 2 cases.

We conclude that UW solution alone may allow satisfactory preservation of intestinal grafts for 48 hours only in isolated cases, and is therefore not adequate for predictable, satisfactory 48 hr preservation. Attempts to prevent reperfusion injury with oxygen-free radical scavengers are in progress.     

改良UW灌注液治疗新生猪急性肾小管坏死的实验研究

目的 通过改良UW(University of Wisconsin solution)肾保存液在体肾动脉灌注,探讨改良UW肾保存液对新生猪急性肾小管坏死的治疗作用.方法 出生1周无特殊病原体幼猪10只,通过夹闭肾动脉制作急性肾小管坏死动物模型,将其分为模型组和改良UW灌注治疗组,每组5只,另设5只为假手术组.分别记录术后各组幼猪12 h、1 d、2 d、3 d、7 d的尿量并进行尿蛋白定量及静脉血中尿素氮(BUN)和肌酐(Cr)含量的检测,同时于术后12 h、24 h及7 d行肾脏病理学检查.结果 10只幼猪经肾脏病理和血生化检查证实建模成功,术后12 h模型组和灌注治疗组BUN和Cr含量明显高于假手术组,差异有统计学意义(P＜0.05),其含量在第2天达到峰值,第7天均显著降低,以灌注治疗组最为显著,并恢复至假手术组水平.尿蛋白定量模型组和灌注治疗组与假手术组比较各时间段均明显升高,差异有统计学意义(P＜0.05或P＜0.01),1 d后达到峰值,后缓慢下降,灌注治疗组下降尤为明显.尿量在模型组各时间段均较假手术组显著减少(P＜0.05或P＜0.01);而灌注治疗组只在12 h、1 d、2 d减少,差异有统计学意义(P＜0.05),在3 d、7d则无统计学意义.肾脏病理学检查提示:与模型组相比灌注治疗组的病理学改变较模型组明显减轻.结论 肾动脉灌注改良UW肾保存液可能具有缓解新生猪急性肾小管坏死程度的作用.

Abstract：

Objective To determine the effect of the modified UW (University of Wisconsin)solution in the treatment of acute renal tubular necrosis in newborn swine. Methods Ten one-week-old newborn swine were used to establish the animal model of acute renal tubular necrosis by clamping their renal arteries,and were divided into two groups: the model group( n = 5 ) and the treatment group ( n = 5 ) in which fructose diphosphate sodium UW solution was used. Sham surgery was performed on other five swine, which were used as the sham group. At 12 h,l d,2 d,3 d and 7 d after the operation,the urine volume,urine protein,blood urea nitrogen(BUN) and creatinine(Cr) were determined. At 12 h ,24 h and 7 d after the operation ,renal pathological examination was conducted. Results The renal pathological examination and the blood biochemistry tests showed that the animal model was successful. BUN and Cr in the model group and the treatment group were significantly higher than those in the sham group at 12 h after operation(P ＜0. 05) ,and they arrived at their peak values at 2 d after operation,showed remarkable decline at 7 d,especially in treatment group,and returned to the level of the sham group. The urine protein in the model group and treatment group were higher than those in the sham group at various times(P ＜0.05 or P ＜0.01) and it peaked at 1 d after operation,then declining gradually,especially in the treatment group. Compared with the sham group,there were a significant decrease in the urine volume at various times in the model group(P ＜0. 05 or P ＜0. 01 ) ,while in the treatment group,the decrease in the urine volume were significant only at 12 h, 1 d and 2 d( P ＜ 0. 05 ) ,and turned insignificant at 3 d and 7 d. The pathological examination showed that the pathological changes in the treatment group were significantly milder than those in the model group. Conclusion The modified UW solution is effective in reducing the acute renal tubular necrosis in newborn swine.     

Comparison of Histidine-Tryptophan-Ketoglutarate and University of Wisconsin Preservation in Renal Transplantation

Histidine-tryptophan-ketoglutarate (HTK) is replacing University of Wisconsin (UW) solution as the preservation fluid for renal allografts in many centers, but recent large-scale data to support this transition are lacking. We conducted a retrospective analysis of patient and graft outcomes after renal transplantation at our center, comparing 475 consecutive living donor and 317 deceased donor transplants since the adoption of HTK with equal numbers of grafts preserved using UW solution. Data collected included donor and recipient age, race, sex, comorbidities and graft ischemia time. Graft and patient survival, as well as the incidence of delayed graft function (DGF), were studied by Kaplan–Meier and Cox regression analysis. No significant difference was seen in either patient or graft survival. Deceased donor kidneys in the HTK group had a higher incidence of DGF than the UW cohort, whereas this trend was reversed in the case of living donor organs. In multivariate analysis, HTK was associated with a significant risk reduction on the incidence of DGF. Prolonged preservation with HTK compared to UW was not associated with excess risk to the graft or patient. In summary, HTK demonstrated efficacy similar to UW in terms of patient and graft survival.     

Effect of University of Wisconsin organ-preservation solution on haemorheology

In conventional cold-storage organ preservation, the donor organ is flushed with University of Wisconsin (UW) solution at 0–4°C. The initial flush is used to wash out blood from the microcirculation to allow optimal preservation with the UW solution. The component hydroxyethyl starch (HES) of UW is known to cause relatively high viscosity and a possible interaction with blood, i.e. increased red blood cell (RBC) aggregation. The aim of this study was to investigate the influence of the HES component on the viscosity of UW and the aggregation behaviour of blood during washout. Viscosity aspects were measured with a cone-plate rheometer. HES-induced RBC aggregation was studied by means of an optical aggregation measuring device. The experiments were carried out with rat whole blood and mixtures of rat whole blood with UW-solution and UW without HES (UWmod), at 4°C. The viscosity of blood at 4°C is two-times higher than at 37°C; the UW/blood mixture at 4°C is 1.3-times more viscous than blood at 37°C; the 4°C UWmod/blood mixture equals the viscosity of blood at 37°C. The UW/blood mixture shows a ninefold increased aggregation compared with whole blood. These aggregates are larger than the diameter of the sinusoids in the rat liver. A mixture of whole blood and UWmod shows a lower aggregation than blood. Apart from an increased viscosity, HES in UW causes increased RBC aggregation. The aggregates are larger than the diameter of the sinusoids. Initial washout could be optimised by pre-flushing to improve the viability of the liver and to decrease delayed graft function.