Associated clinical and laboratory markers of donor on allograft function after heart transplant

Abstract

Introduction: Primary graft dysfunction is a major cause of mortality after heart transplantation. Objective: To evaluate correlations between donor-related clinical/ biochemical markers and the occurrence of primary graft dysfunction/ clinical outcomes of recipients within 30 days of transplant. Methods: The 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. Results: Recipients 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). Conclusion: High 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.