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.

Pressão pulmonar aferida pela ecocardiografia em pacientes chagásicos indicados para transplante cardíaco / Pulmonary pressure by echocardiophy in chagasic patients on heart transplant waiting list

INTRODUÇÃO: O paciente com insuficiência cardíaca desenvolve aumento da pressão pulmonar por mecanismo retrógrado e a hipertensão arterial pulmonar (HP) é um marcador de mau prognóstico. OBJETIVO: Correlacionar pressão pulmonar ao ecogardiograma (eco) e ao cateterismo, em pacientes em lista de espera para transplante cardíaco (TC), especialmente nos chagásicos. MÉTODOS: Avaliamos 90 pacientes no HC-UFMG entre 2004 e 2009. Todos realizaram cateterismo e eco no pré-transplante. A idade média foi de 45,5 anos, sendo 68(75,6%) homens, 42(46,7%) chagásicos, 32(35,6%) portadores de miocardiopatia dilatada e 10(11,1%) isquêmicos. RESULTADOS: A eco-PSAP (pressão sistólica arterial pulmonar) média foi de 45 ± 12mmHg. A cat-PSAP média foi de 47 ± 14mmHg. A eco-PSAP-chagásicos foi 41,7 ±12,5 mmHg e não-chagásicos, 47,6 ±12,8 mmHg P=0,04. A cat-PSAP-chagásicos foi de 46 ±12,1 mmHg e não-chagásicos 48,7±12,8mmHg; P=0,43. Oito pacientes apresentavam cat-PSAP>60. A correlação entre a eco-PSAP e o cat-PSAP nos chagásicos foi r=0,45, P=0,008 e nos não-chagásicos de r=0,66, P<0,001. A eco-PSAP-chagásico >32,5mmHg tem uma sensibilidade de 79% e especificidade de 75% para diagnosticar HP, com área sob a curva ROC de 0,819. A eco-PSAP-não chagásico>35,5 mmHg tem sensibilidade de 82% e especificidade de 70% para HP, com área sob a curva ROC de 0,776. CONCLUSÕES: Há boa correlação entre a eco-PSAP e a cat-PSAP (r=0,54) entre os pacientes em fila de espera. A eco-PSAP foi menor no grupo dos chagásicos. O ecocardiograma é um método útil para diagnosticar e monitorar a pressão pulmonar previamente ao TC, especialmente em pacientes chagásicos. Entretanto, não é possível prescindirmos do cateterismo para avaliar a reatividade pulmonar com o teste com vasodilatador e indicar com segurança o TC mesmo nos pacientes chagásicos.

INTRODUCTION: The patients suffering heart failure develop an increase in pulmonary pressure because of a retrograde mechanism. The pulmonary hypertension is a prognostic marker. OBJECTIVE: The aim of this study is to correlate pulmonary hypertension measured by echocardiogram versus catheterization in pre-heart transplant patients on waiting list. METHODS: Data from 90 patients of the Clinical Hospital UFMG were collected between 2004 and 2009. All the patients took an echo and catheterization as an integral part of pre-heart transplant. Mean age was 45.5 years old, 68 (75.6%) male. Fourty-two (46.7%) were Chagas' disease patients, 32 (35.6%) presented idiopathic dilated cardiomyopathy, 10 (11.1%) had ischemic cardyomiopathy. RESULTS: The mean eco-PASP was 45 ± 12mmHg). The mean cat-PASP was 47 ±14mmHg. The eco-PASP-Chagas was 41.7 ±12,5 mmHg and non-Chagas 47.6 ±12.8 mmHg P=0.04. The cat-PASP-Chagas was 46 ±12.1 mmHg and non-Chagas 48.7 ±12.8 mmHg P=0.43. Eight patients had cat-PASP>60. The correlation between eco-PASP and cat-PASP in Chagas' patients was r=0.45; P=0.008 and in the non-Chagas was r=0.66; P<0.001. The eco-PASP-Chagas>32,5mmHg has a sensitivity of 79% and specificity of 75% to diagnose PH, with an area under the curve of 0.819. The eco-PASP-non-Chagas>35.5 mmHg has a sensitivity of 82% and a specificity of 70% to diagnose PH, with an area under the curve of 0.776. CONCLUSIONS: There is a good correlation between eco-PASP and cat-PASP (r=0.54) in pre-heart transplant patients. The eco-PASP was lower in the Chagas' group. The echocardiogram is an important method to diagnosis and control pulmonary pressure in pre-heart transplant, specifically in Chagas' patients. The catheterization is still important to evaluate pulmonary reactivity during vasodilation test.