Abstract 17506: Recipient Anemia Accelerates Cardiopulmonary Bypass-related Inflammatory Response to Cause Primary Graft Failure in Adult Heart Transplantation
Background: Primary graft failure (PGF) is associated with poor outcome after heart transplantation (HTX). While donor factors have been intensively studied as a cause of PGF, recipient factors are not fully understood. We herein hypothesized that systemic inflammatory response in the recipient, triggered by operative intervention, may be associated with PGF post- HTX.
Method: An institutional consecutive series of 57 patients undergoing adult HTX since 2007 were enrolled in this study. Blood plasma was sampled before cardiopulmonary bypass, at the time of donor heart reperfusion, at 1 hour and at 24 hours after reperfusion to measure interleukin (IL)-6 and IL-8. PGF was defined according to the severity scale by The International Society of Heart Lung Transplantation consensus meeting 2014. The cohort was divided into 14 patients (24.5%) developing moderate to severe PGF and the remaining 43 patients.
Result: Donor factors, such as age, gender, cardiac function or ischemic time, were not significantly different between the 2 groups. In addition, background or characteristics of the recipients, including age, gender, assist device or preoperative status, was not significantly different between the 2 groups. Although IL-6 was not different between the 2 groups prior to the cardiopulmonary bypass, the PGF group exhibited a significantly higher IL-6 than the non-PGF group at the time of reperfusion, 1 hour and 24 hours after reperfusion. In contrast, IL-8 was not significantly different over the study period. Interestingly, hemoglobin level at the time of reperfusion was significantly lower in the PGF group (7.8±1.2 mg/dl) than that in the non-PGF group (9.3±1.1 mg/dl, P <0.0001). Among studied parameters, hemoglobin was a sole factor that was significantly correlated with plasma IL-6 at the time of reperfusion (r = -0.618, P = 0.0206) with areas under the receiver operating characteristic curves being 0.825. The cutoff level of hemoglobin was 9.1 mg/dl with a sensitivity and specificity of 100% and 56%, respectively.
Conclusions: PGF after HTX was related to plasma IL-6 and hemoglobin levels of the recipient at the time of the reperfusion of the donor heart, suggesting that perioperative management of the recipient may be important to prevent PGF post-HTX.
Author Disclosures: Y. Nakamura: None. S. Saito: None. S. Miyagawa: None. Y. Yoshikawa: None. S. Fukushima: None. K. Domae: None. K. Kubota: None. K. Toda: None. Y. Sawa: None.
- © 2016 by American Heart Association, Inc.