Associated Clinical and Laboratory Markers of Donor on Allograft Function After Heart Transplant

Abstract

IntroductionPrimary graft dysfunction is a major cause of mortality after heart transplantation.ObjectiveTo evaluate correlations between donor-related clinical/biochemical markers and the occurrence of primary graft dysfunction/clinical outcomes of recipients within 30 days of transplant.MethodsThe prospective study involved 43 donor/recipient pairs. Data collected from donors included demographic and echocardiographic information, noradrenaline administration rates and concentrations of soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2), interleukins (IL-6 and IL-10), monocyte chemoattractant protein-1, C-reactive protein and cardiac troponin I. Data collected from recipients included operating, cardiopulmonary bypass, intensive care unit and hospitalization times, inotrope administration and left/right ventricular function through echocardiography.ResultsRecipients who developed moderate/severe left ventricular dysfunction had received organs from significantly older donors (P =0.020). Recipients from donors who required moderate/high doses of noradrenaline (>0.23 µg/kg/min) around harvesting time exhibited lower post-transplant ventricular ejection fractions (P =0.002) and required longer CPB times (P =0.039). Significantly higher concentrations of sTNFR1 (P =0.014) and sTNFR2 (P =0.030) in donors were associated with reduced intensive care unit times (≤5 days) in recipients, while higher donor IL-6 (P =0.029) and IL-10 (P =0.037) levels were correlated with reduced hospitalization times (≤25 days) in recipients. Recipients who required moderate/high levels of noradrenaline for weaning off cardiopulmonary bypass were associated with lower donor concentrations of sTNFR2 (P =0.028) and IL-6 (P =0.001).ConclusionHigh levels of sTNFR1, sTNFR2, IL-6 and IL-10 in donors were associated with enhanced evolution in recipients. Allografts from older donors, or from those treated with noradrenaline doses >0.23 µg/kg/min, were more frequently affected by primary graft dysfunction within 30 days of surgery.

Primary graft dysfunction after heart transplantation: a thorn amongst the roses

“…A Brazilian group showed recipients receiving grafts from donors expressing lower concentrations of plasma soluble tumour necrosis factor receptors 2 (sTNFR2) and IL-6, required more inotropic support post-transplantation [145].…”

Neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio as predictors of survival after heart transplantation

“…After surgery, graft inflammation may respond to several mechanisms, from alloantigen‐directed immune reactions of the recipient resulting in graft rejection to ischaemia/reperfusion injury of the graft 7. Inflammation of the donor before explantation is also associated with worse outcome of the recipient 8, 9…”

“…7 Inflammation of the donor before explantation is also associated with worse outcome of the recipient. 8,9 Neutrophil-to-lymphocyte ratio (NLR) is a marker of inflammation. First described in 1967 as an indicator of ozone exposure, 10 NLR has shown prognostic value in different cardiovascular conditions including stable coronary artery disease, acute coronary syndromes, HF, and coronary artery bypass grafting (CABG).…”

Hurdles to Cardioprotection in the Critically Ill

“…Inotropic support is vital for management of the hemodynamic compromise during donor BD, however, in a potentially desensitized organ, additional exogenous catecholamine exposure may only add insult to injury. Indeed, high inotrope dependence and significant myocardial dysfunction can prohibit organ donation (based on medical grounds) [340,341]. Due to the shortage of acceptable donor hearts, several studies have demonstrated that using these “extended criteria” donors on high inotrope support is an acceptable strategy for expanding the donor pool [342,343,344].…”