Outcomes of Abdominal Organ Transplantation Using Custodial HTK Preservation Solution

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Outcomes of Abdominal Organ Transplantation Using
Custodial HTK Preservation Solution

• David C. Mulligan, MD, FACS
• Chair, Transplant, Hepatobiliary Pancreatic
  Surgery
• Professor of Surgery, Mayo Clinic School of
  Medicine
• Mayo Clinic Arizona

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Mayo ClinicLargest Transplant Entity in U.S.
1469 Total Transplants in 2006
717
446
306
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Mayo Clinic Data 2007
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MCA Abdominal Organ Transplant HistoryThen and
Now

• Liver Transplant Program
• Deceased Donor Liver Transplantation (1999)
• 2007 33rd out of 127 programs in US
• Living Donor Liver Program (2001) 1st in AZ
• 2006 7th largest in the US
• 2007 5th largest out of 71 programs
• Kidney Transplant Program
• 2007 22nd largest out of 245 programs overall
• Living Donor Kidney Program (1999)
• 2006 15th largest in the US
• 2007 12th largest out of 245 programs
• Laparoscopic Donor Procedure (1999)
• First in the Foundation Arizona
• Pancreas Transplant Program
• November 2002 UNOS Certified
• First K/P Transplant in July 2003
• 2006 7th largest in the US
• 2007 3rd largest not factoring pancreas alone

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MCA Liver Transplantation Program

• 1999 to 2007 Volume Data
• Liver Transplants - 411
• Living Donor Transplants - 77 (19)
• 2007 Volume Data
• Liver Transplants - 66
• 13 of 66 Transplants - Living Donor
• 2006 Outcome Data
• 1 Year Patient Survival
• 91.85 Actual vs. 88.18 National Avg (Combined)
• 1 Year Graft Survival
• 89.41 Actual vs. 84.43 National Avg (Combined)

SRTR National Data Base - January 2007 Release
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Mayo System and National Comparison 1 Year
Patient and Graft Survival
SRTR National Data Base - January 2007
Release Deceased Donor Only for Appropriate
Comparison
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Mayo System and National ComparisonMedian Length
of Stay Post Transplant
SRTR National Data Base - January 2007
Release Median LOS for Deceased Donor
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Liver Waitlist Transplants2001 - 2007
Wait List Size as of Last Day of Year
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Etiology of Liver Disease
Q1 2007
Liver disease transplanted Q1 2007
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Cold Ischemia Time (hours)Cumulative

• Average CIT 5.95 hrs
• Median CIT 5.75 hrs
• Range 1.5 -23 hrs

Q1 2007
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Benchmarking National Centers of Excellence
UNOS Patient Survival Data(1/01/04 - 6/30/06 w/
1 Mo. 1 Yr. Cohorts 01/01/01 - 6/30/03 w/ 3
Yr. Cohort)
Q4 2007
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Benchmarking National Centers of Excellence
UNOS Graft Survival Data (1/01/04 - 6/30/06 w/ 1
Mo. 1 Yr. Cohorts 7/01/01 12/31/03 w/ 3 Yr.
Cohort)
Q4 2007
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Kidney / Pancreas Transplant Program2007
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MCA Kidney Transplantation Program

• 1999 to 2007 Volume Data
• Kidney Transplants - 890
• Living Donor Kidney Transplants - 455 (51)
• Pancreas Transplants - 70
• 2007 Volume Data
• Kidney Transplants - 185
• Living Donor Kidney Transplants - 88 (51)
• Pancreas Transplants - 30
• 2006 Outcome Data Kidney Transplant
• 1 Year Patient Survival
• 96.13 Actual vs. 96.47 Expected
• 1 Year Graft Survival
• 92.83 Actual vs. 93.34 Expected

SRTR National Data Base - January 2007
Release Combined Living and Deceased Donor
Transplants
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Mayo System and National Comparison 1 Year
Patient and Graft Survival
SRTR National Data Base - January 2007
Release Combined Living and Deceased Donor
Transplants
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Mayo System and National ComparisonLength of
Stay - Time on Wait List
SRTR National Data Base - January 2007
Release LOS for Deceased Donor, Wait Times
Includes Both Living and Deceased Donor
Transplants
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Kidney Waitlist Transplants2001 - 2007
Wait List Size as of Last Day of Year
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Donor Source (N654)Cumulative

• Living Related Donor 238
• Living Unrelated Donor 154
• Deceased Donor 262

Q1 2007
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Pancreas Transplantation at MCA
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Pancreas Transplants at MCA by type of transplant
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Type of Surgical Procedure
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MCH Patient/Graft Survival for KP Txs
(Kaplan-Meier)
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MCH Patient/Graft Survivalfor PAK PTA
(Kaplan-Meier)
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Immunosuppression

• Thymoglobulin
• Prograf
• MMF
• Long-term steroids

• Campath
• Prograf
• MMF
• Rapid steroid taper

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Acute Rejection during the first year

• Kidney-Pancreas 17
• Solitary Pancreas 32

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Kidney-Pancreas Steroid Avoidance

• 37 patients
• Patient survival 100
• Graft Survival
• Kidney 97
• Pancreas 95
• Acute Rejection 11

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Pancreas Experience with HTK(n100)

• Mean CIT 9.6hrs (4hrs 22.9hrs)
• Less than 12hrs 77
• 12 to 15.9hrs 18
• Greater than 16hrs 5
• No cases of graft pancreatitis or vascular
  thrombosis due to preservation

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Historical Total Transplant Volumes 2001 to
present
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Conclusions

• Strong clinical academic solid organ transplant
  practice with complete conversion from UW to
  Custodial HTK in 2003 without any negative effect
• Improved outcomes using Custodial for Living
  Donor Liver Transplantation
• Recommendation for HTK for DCD donors to improve
  outcomes