P3840 - Cold Normal Saline as a Preservative Solution for Complex and Technically Challenging Liver Grafts Requiring Back-Table Reconstruction With Longer Cold Ischemia Time
SUNY Upstate Medical University, New York Syracuse, New York
Abdul Wahab Dogar, MBBS, FCPS1, Azhar Hussain, MD2, Kaleem Ullah, MBBS, FCPS1, Shams Ud-Din, MBBS, FCPS1, Abdul Ghaffar, MBBS, FCPS1, Ameer Hamza, MBBS, FCPS1, Abu Hurairah, MD3 1Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Sindh, Pakistan; 2SUNY Upstate Medical University, New York, Syracuse, NY; 3AdventHealth, Orlando, FL
Introduction: To asses feasibility and safety of selected liver grafts flushed with cold normal saline (NS) and compare their outcomes with Histidine-Tryptophan-Ketoglutarate (HTK) solution for grafts that require back-table reconstruction.
Methods: One hundred adult recipients who underwent right lobe LDLT at the Department of Liver Transplantation Surgery, Gambat, Pakistan, were studied. After informed and written consent, recipients were randomized via lottery method and assigned to receive either “Cold Normal Saline” (cases/non-HTK group, who require back table reconstruction; n=50) or “Histidine-Tryptophan-Ketoglutarate (HTK) solution” (controls/HTK group, who require back table reconstruction; n=50).
Results: Demographics and clinical characters were comparable in the two groups (Table 1). Comparing cases vs. controls, mean bilirubin, ALT, AST, and INR on the 7th postoperative day were similar in the two groups. 5(10%) cases and 4(8%) controls developed EAD (p=0.72). Post-LT complications (biliary leak 2% in cases vs. 0 in control), strictures (12% in cases vs. 16% in controls), hepatic artery thrombosis (4% vs. 2%) and portal vein thrombosis (0 vs. 2%) were equally distributed. Mean hospital stay (11.02 + 2.63 and 12.06 + 3.68 days) and 30-day mortality (8% vs 8%) were also comparable in two groups. Finally, 1-year survival (92% vs 90%) based on Kaplan-Meier analysis was also comparable (p= 0.71). The cost of using a non-HTK/normal saline-based approach was much lesser than the HTK solution (1 USD vs 2000 USD).
Discussion: In this study, we evaluated the impact of cold normal saline as a preservative solution for live liver grafts requiring back-table reconstruction and compared it with HTK solution in terms of early allograft dysfunction, postoperative complications (biliary & vascular), hospital stay & readmission, and one-year survival. The direct cost of both approaches was also reported. This study concludes that there is no difference in various post-LDLT outcomes, mean hospital stay, 30-day mortality, and 1-year survival were comparable in the two groups. The cost of using a non-HTK/normal saline-based approach was much lesser than the HTK solution.
We conclude that in a selected cohort of right-lobe LDLT recipients, preservation solutions can be avoided safely with comparable outcomes. In high-volume LDLT centers, avoiding preservation use can also result in saving costs without impacting outcomes.
Disclosures:
Abdul Wahab Dogar indicated no relevant financial relationships.
Azhar Hussain indicated no relevant financial relationships.
Kaleem Ullah indicated no relevant financial relationships.
Shams Ud-Din indicated no relevant financial relationships.
Abdul Ghaffar indicated no relevant financial relationships.
Ameer Hamza indicated no relevant financial relationships.
Abu Hurairah indicated no relevant financial relationships.
Abdul Wahab Dogar, MBBS, FCPS1, Azhar Hussain, MD2, Kaleem Ullah, MBBS, FCPS1, Shams Ud-Din, MBBS, FCPS1, Abdul Ghaffar, MBBS, FCPS1, Ameer Hamza, MBBS, FCPS1, Abu Hurairah, MD3. P3840 - Cold Normal Saline as a Preservative Solution for Complex and Technically Challenging Liver Grafts Requiring Back-Table Reconstruction With Longer Cold Ischemia Time, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.