Luigi Boschiero

A comparative prospective study of two available solutions for kidney and liver preservation

Background. Viaspan (University of Wisconsin [UW]) solution is the gold standard for abdominal organ preservation. Celsior (CEL) is an extracellular-type, low-potassium, low-viscosity solution, initially used for heart and lung preservation. We have performed a prospective multicenter study to compare the role of these cold-storage solutions on kidney and liver recovery after transplantation. Patients and Methods. From March 15, 2000 to December 31, 2001, 441 (172 CEL and 269 UW) renal transplants (RT) and 175 (79 CEL and 96 UW) liver transplants (LT) were included in the study. Results. Perfusate volume used was significantly lower in the UW group, being 4,732±796 mL versus 5,826±834 mL in the CEL group (P <0.001). In LT, median total bilirubin serum levels were significantly higher at 5 and 7 posttransplant days in the UW group (90.6 and 92.3 μmol/L, respectively) as compared with CEL (51.3 and 63.4 μmol/L, respectively). After LT, primary nonfunction (PNF) rates in the CEL and UW groups were 3.8% and 4.2% (P =NS) respectively, with 1-year graft and patient survival being 83.3% versus 85.4% (P =NS) and 89.9% versus 90.6% (P =NS). After RT, delayed graft function (DGF) rates were 23.2% and 22.7% (P =NS), respectively; PNF rates were 1.9% and 1.7% (P =NS) respectively, with 1-year graft and patient survival being 92.3% versus 94.2% (P =NS) and 99.4% versus 97.7% (P =NS). Conclusions. CEL solution was shown to be as effective as UW in both liver and kidney preservation. In LT patients, biliary function recovery is significantly better in the CEL group. CEL solution represents an efficacious option in multiorgan harvesting.

Incidence of second primary cancer in transplanted patients.

Background. Solid organ transplanted patients have a three- to fourfold higher lifetime risk of developing a cancer than the general population. However, the incidence of a second primary cancer in transplanted patients has never been studied, despite the fact that the presence of regular follow-ups and the increased survival of these patients make them a very attractive model. Methods. We investigated the incidence of a second primary cancer (SPC) in 7,636 patients who underwent a kidney, liver, lung or heart transplant between 1970 and 2004, and were followed-up for 51,819 person-years. Results. During the follow-up, 499 subjects developed a first cancer (annual incidence: 98.6×10,000 PY), and 22 of them developed a SPC (annual incidence: 3.9×10,000 PY). The annual incidence of a SPC in the transplanted patients who developed a first cancer was 107.8×10,000 PY, giving a standardized incidence ratio of 1.1 (95% CI: 0.83–1.41). Conclusions. This result shows that the incidence of the SPC was the same as the incidence of a first cancer. Our study does not indicate an increased risk of SPC in transplanted subjects who already suffered a first malignancy.