Ischemia-Reperfusion Injury and Organ Preservation for TransplantationPreservation solutions for transplantation
Section snippets
Collins solution
Many preservation solutions were developed along with research efforts to find appropriate cardioplegic solutions, and one of the first solutions for kidney preservation was developed by G.M. Collins in laboratories in Los Angeles.3 This Collins solution was modified by the Eurotransplant Organization4 by taking out magnesium without negative effect on preservation results. This Eurocollins solution was cheap but not quite simple in use because sterilization of the glucose-containing fluid had
University of Wisconsin solution
Continuous research effort headed by one of the pioneers of organ preservation,5 Folkert O. Belzer, resulted in a development of a new preservation solution that introduces three new philosophies: (a) osmotic concentration is no longer maintained by metabolically active glucose, it is rather achieved by the administration of metabolically inert substrates like lactobinat and raffinose; (b) much attention is paid to the additional administration of colloid carrier hydroxyethylstarch (HES); (c)
Histidin-Tryptophan-Ketoglutarat solution
Histidin-Tryptophan-Ketoglutarat solution (HTK) was introduced by H.J. Brettschneider from Göttingen, Germany, who was interested in developing a physiologic cardioplegic solution.9 The basic philosophy is the introduction of a very potent buffer system, which is Histidin, along with the two substrates.
The HTK solution has a very low viscosity and according to Brettschneider, high volumes at a low flow rate should be applied to guarantee “equilibration.” HTK has been tested in clinical trials.
Celsior
The Celsior preservation solution created by Pasteur-Merieux is a mixture of the impermeant inert osmotic carrier philosophy from the Belzer solution, using lactobionat and mannitol, and the strong buffer philosophy from the HTK solution using 30 mmol of histidin buffer. (Table 1) In addition, Celsior also contains oxygen radical scavengers. From the electrolyte point of view, Celsior is a high sodium, low potassium solution that is unique in this respect. Celsior has been used clinically in
Summary
Eurocollins has almost been abandoned because of the glucose disadvantage. UW is certainly the most used preservation solution for livers, kidneys, and pancreases with excellent clinical and experimental preservation data. UW can certainly be considered the current golden standard solution. However, the disadvantage of high viscosity, high price, uneasy handling of many 1-L bags, and the fact that the radical scavenger glutathion cannot be detected in the bags by chemical analysis (presumably
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