Donor serum SMARCAL1 concentrations predict primary graft dysfunction in cardiac transplantation.
BACKGROUND
Primary graft dysfunction (PGD) is a life-threatening complication in cardiac transplantation. A sensitive, specific, and easily measurable predictor in donors could facilitate PGD prevention.


RESULTS
SMARCAL1 is a matrix-associated regulator of chromatin with helicase and ATPase activities, and its serum concentrations were significantly increased in a targeted protein array in donors whose grafts developed PGD. Therefore, this study analyzed SMARCAL1 serum concentrations by ELISA in 336 heart donors before and after aortic cross-clamping (ACC) and in recipients at 10, 30, and 60 minutes reperfusion. Demographic and hemodynamic parameters of donors and recipients as well as transplant procedure characteristics were documented. PGD (n=68) was defined as ventricular dilation and hypocontractility associated with systolic blood pressure <90 mm Hg, pulmonary capillary wedge pressure >20 mm Hg, and decreased mixed venous oxygen saturation necessitating mechanical circulatory support. SMARCAL1 serum protein concentration was significantly increased only before and after ACC in donors (P<0.0001) whose grafts developed PGD compared to those who did not. In receiver operating characteristic curve analysis, SMARCAL1 serum concentration at a cut-off level of > or =1.25 ng/mL before ACC in donors predicted PGD (P<0.0001, AUC=0.988, OR=17.050, 95% CI=5.200 to 55.901) with 96% sensitivity and 88% specificity. SMARCAL1 serum concentrations <1.25 ng/mL in donors before ACC resulted in 97% PGD-free outcome and SMARCAL1 concentrations > or =1.25 resulted in 83% PGD occurrence.


CONCLUSIONS
Donor serum SMARCAL1 may serve as a specific, sensitive, and noninvasive predictive marker in the assessment of cardiac graft quality.
Aharinejad
Seyedhossein
S
Department of Cardiothoracic Surgery, Medical University of Vienna, Austria. seyedhossein.aharinejad@meduniwien.ac.at
Andrukhova
Olena
O
Gmeiner
Matthias
M
Thomas
Anita
A
Aliabadi
Arezu
A
Zuckermann
Andreas
A
Krenn
Katharina
K
Grimm
Michael
M
D000328:Adult; D000368:Aged; D004265:DNA Helicases / Q000097:blood* / Q000235:genetics; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D055031:Primary Graft Dysfunction / Q000175:diagnosis*; D012333:RNA, Messenger / Q000032:analysis; D015996:Survival Rate; D014019:Tissue Donors
D012333:RNA, Messenger; C412482:SMARCAL1 protein, human; D004265:DNA Helicases