title: Preoperative recipient cytokine levels are associated with early lung allograft dysfunction.
abstract: BACKGROUND
  Primary graft dysfunction (PGD) is a morbid complication after lung transplant (LTx). Recipient before and after cytokine and chemokine profiles may be associated with a recipient's propensity to have PGD.
  
  
  METHODS
  Serum samples were obtained from adult (more than 17 years old) primary LTx recipients (2002 to 2007) at two time points: (1) pre-reperfusion of transplanted lungs, and (2) within 24 hours after reperfusion. Interleukin (IL)-6, IL-8, IL-10, chemokine ligand (CCL)-2, and matrix metalloproteinase (MMP)-9 levels were determined. A PaO2/FiO2 ratio less than 300 at 48 hours (International Society for Heart and Lung Transplantation PGD grade 2 or more) was used to stratify patients. Follow-up was obtained through August 2009. Cytokine levels at both time points and the change in levels were assessed for association with PGD grade 2 or more. Outcomes and clinical characteristics were analyzed.
  
  
  RESULTS
  Of 28 patients, 8 (28.6%) had PGD grade 2 or more. Median follow-up was 23 months (interquartile range, 16 to 31). Demographics, clinical data, and pre-LTx diagnoses did not differ between the groups. Patients who had PGD grade 2 or more had higher baseline levels of IL-10, IL-8, IL-6, and CCL-2 (all p<0.05). Within 24 hours, PGD grade 2 or more patients had higher IL-10 (p=0.02) and CCL-2 (p=0.04) levels. The PGD grade 2 or more patients were more likely to have had cardiopulmonary bypass during LTx (p=0.002) and blood products administered: platelets (p=0.004), plasma (p=0.05), and packed red blood cells (p=0.03)]. The PGD grade 2 or more patients had longer length of stay, duration of mechanical ventilation, and total intensive care unit days.
  
  
  CONCLUSIONS
  Higher before and after transplant cytokine/chemokine levels were found in LTx recipients who subsequently had PGD grade 2 or more. Our study demonstrates that the recipient's inflammatory state at the time of LTx may impact early allograft function. That could represent a potential target for pretransplant pharmacologic intervention.
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: Jeremiah G
authors.initials: JG
authors.lastname: Allen
authors.forename: Maria T
authors.initials: MT
authors.lastname: Lee
authors.forename: Eric S
authors.initials: ES
authors.lastname: Weiss
authors.forename: George J
authors.initials: GJ
authors.lastname: Arnaoutakis
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
authors.forename: Barbara
authors.initials: B
authors.lastname: Detrick
mesh_terms: D000328:Adult; D000368:Aged; D018925:Chemokines / Q000097:blood; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016040:Lung Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D055031:Primary Graft Dysfunction / Q000276:immunology* / Q000401:mortality; D011379:Prognosis; D012121:Respiration, Artificial / Q000706:statistics & numerical data
chemical_list: D018925:Chemokines; D016207:Cytokines; D010100:Oxygen