Procalcitonin, a donor-specific predictor of early graft failure-related mortality after heart transplantation.
BACKGROUND
To date, donor-specific markers to predict outcome after heart transplantation (HTx) are unknown. Increased procalcitonin (PCT) levels have been found in infectious inflammation with systemic reactions and/or poor organ perfusion but have not been studied in heart donors. We evaluated PCT as a predictor of early graft failure-related mortality after HTx.


RESULTS
PCT and C-reactive protein (CRP) serum concentrations were measured in samples collected immediately before pericardium opening from 81 consecutive brain-dead multiple-organ donors. Donors for high-urgency-status recipients (n=2) were excluded from analysis. The remaining donors were retrospectively divided into 2 groups: donors for recipients who died within 30 days after HTx, after an early graft failure (group II, n=8), and all other donors (group I, n=71). No differences in donor and recipient demographic characteristics were found between groups. Areas under the receiver operating characteristic curves for graft failure-related mortality were 0.71 for PCT and 0.64 for CRP. A PCT value >2 ng/mL as a predictor of graft failure-related mortality had a specificity of 95.8% and sensitivity of 50.0%. The odds ratio for graft failure-related mortality for recipients of hearts from donors with PCT levels >2 ng/mL was 22.7 (unadjusted, 95% CI 3.7 to 137.8, P=0.0007) and 43.8 (after adjustment for prespecified potential confounders, 95% CI 1.4 to 1361.0, P=0.031).


CONCLUSIONS
A PCT level >2 ng/mL in a cardiac donor at the time of explantation appears to predict early graft failure-related mortality.
Wagner
F D
FD
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. wagner@dhzb.de
Jonitz
B
B
Potapov
E V
EV
Qedra
N
N
Wegscheider
K
K
Abraham
K
K
Ivanitskaia
E A
EA
Loebe
M
M
Hetzer
R
R
D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality* / Q000517:prevention & control; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007239:Infections / Q000097:blood / Q000175:diagnosis*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014019:Tissue Donors
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide