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Biomarkers and Donor Selection in Heart Transplantation.

Authors :: Vorlat A
De Hous N
Vervaecke AJ
Vermeulen T
Van Craenenbroeck E
Heidbuchel H
Rodrigus I
Van Donink W
Ancion A
Van Cleemput J
Van Hoof VO
Claeys MJ
Source :: Transplantation proceedings [Transplant Proc] 2019 Jul - Aug; Vol. 51 (6), pp. 1673-1678. Date of Electronic Publication: 2019 Jul 12.
Publication Year :: 2019
Abstract: Background: Previously, we showed that B-type natriuretic peptide (BNP) measured in the donor was related to cardiac performance after cardiac transplantation. The present study assesses the value of 3 biomarkers in the selection of donor hearts in a larger cohort.<br />Methods: Blood samples were prospectively obtained in 105 brain-dead patients scheduled for heart donation. BNP, soluble suppressor of tumorigenicity 2 (ST2), and troponin of heart donors were correlated with hemodynamic parameters early after transplantation as well as with the mortality of the recipients.<br />Results: A significant inverse relationship was found between donor BNP measured at the time of donation and recipient cardiac index and cardiac output at day 13 post-transplantation (r = -0.31, P = .005, and r = -0.34, P = .0016, respectively). Logistic regression analysis-including BNP, ST2, and troponin-showed that donor BNP was a predictor of a poor cardiac index (< 2.2 L/min/m <superscript>2</superscript> ) in the recipient (P = .04). A donor BNP > 132 pg/mL has a sensitivity of 56% (95% confidence interval 21-86) and a specificity of 86% (95% confidence interval 77-93) to predict poor cardiac performance in the recipient. When the donor BNP is ≤ 132 pg/mL, the risk of a poor cardiac function in the recipient is very low (negative predictive value 94%). Mortality at 30 days was also correlated to donor BNP (r = 0.29, P = .0029). Long-term survival of the recipient was not correlated to the biomarkers measured in the donor.<br />Conclusion: Donor BNP, but not donor ST2 or high-sensitivity troponin, provides information on the donor heart and early post-transplant performance, including 1-month mortality.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)