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(Circulation. 2001;104:I-192.)
© 2001 American Heart Association, Inc.

Thoracic Transplantation and Ventricular Assist Devices

Procalcitonin, A Donor-Specific Predictor of Early Graft Failure-Related Mortality After Heart Transplantation

Frank D. Wagner, MD; Britta Jonitz, MD; Evgenij V. Potapov, MD; Naser Qedra, MD; Karl Wegscheider, MD, PhD; Klaus Abraham, MD; Ekaterina A. Ivanitskaia, MD; Matthias Loebe, MD, PhD; Roland Hetzer, MD, PhD

Department of Cardiothoracic and Vascular Surgery (F.D.W., B.J., E.V.P., N.Q., K.A., E.A.I., R.H.), Deutsches Herzzentrum Berlin, Berlin, Germany; the Department of Biometrics and Statistics (K.W.), University of Hamburg, Hamburg, Germany; and Michael E. DeBakey Department of Surgery (M.L.), Division of Transplantation and Assist Devices, Baylor College of Medicine, Houston, Tex.

Correspondence to Frank D. Wagner, MD, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail wagner{at}dhzb.de

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.

Methods and 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.

Key Words: transplantation • mortality • heart failure • infection • procalcitonin