Abstract 17331: Utility of the Interleukin Receptor Family Member ST2 in Predicting Allograft Rejection and Long-term Survival After Heart Transplantation
Introduction: ST2, a member of the interleukin-1 receptor family is involved in immune tolerance, and also has a prognostically meaningful role in myocardial fibrosis and remodeling in heart failure. We hypothesized that concentrations of soluble ST2 (sST2) would be associated with rejection and prognosis in patients post orthotopic heart transplantation (OHT).
Methods: Patients undergoing surveillance endomyocardial biopsy (EMB) ≥31 days from OHT were studied; concentrations of sST2 (from blood drawn a median of 1 day from EMB) were examined as a function of cellular (≥1R) and antibody-mediated rejection (AMR), as well as long-term mortality.
Results: 241 subjects (mean age 51 years; 81% male) were studied; median time from OHT to sample collection was 2.1 years. The median sST2 concentration was 16 ng/mL; those above the sST2 median were similar to those below with respect to demographic and clinical characteristics, however, those with a supra-median sST2 were more likely to have acute cellular rejection (33% vs 22%, P =.06). The highest rate of acute cellular rejection was in the 4th sST2 quartile (≥30 ng/mL; 42% vs 23% below, P = .003); in adjusted analyses, an sST2 value ≥30 ng/mL independently predicted acute cellular rejection (HR= 1.54; 95% CI 1.09–2.19; P =.02). No association between sST2 and AMR was found. Over a median follow up of 7.1 years (range 0.7–23.7 years), there were 62 deaths. Median sST2 values trended higher in decedents versus survivors (19.6 vs 14.7 ng/mL; P =.08); examined by sST2 quartiles, a graded risk for death was found in adjusted analyses (Figure). In Cox proportional hazards analysis, an sST2 ≥30 ng/mL independently predicted death following OHT (HR=2.01; 95% CI 1.15–3.51; P =.01).
Conclusions: Concentrations of sST2 predict cellular rejection and long-term mortality following OHT. If prospectively validated, sST2 may be used as a screening tool for rejection or for the identification of patients at risk for death following OHT.
- © 2010 by American Heart Association, Inc.