Primary graft failure (PGF) is defined as severe ventricular dysfunction immediately following heart transplantation (HTx) requiring temporary mechanical circulatory support (MCS) such as VA ECMO or VAD. PGF is a critical determinant of mortality in the first month following HTx. The pathophysiology of PGF is unclear. Some reports suggest that a pre-activated immune system can predispose transplant recipients to PGF. In this study, we sought to identify pro-inflammatory factors in pre-transplant serum that are associated with PGF. We used archived serum collected from 58 HTx patients at one large volume center between 2011- 2014. 29 cases of PGF and 29 non-PGF controls were matched by age, sex, year of transplant, and pre-transplant requirement of MCS. We used Luminex assay to quantify 19 inflammatory/immune-related factors, including cytokines, chemokines, and matrix metalloproteinases in the pre-transplant serum specimens. Comparisons between PGF cases and controls were made non-parametrically with the Mann–Whitney U test and logistic regression. Seven pro-inflammatory markerswere significantly higher in the serum of patients who developed PGF vs controls : TNF-α, IL-1ß, VCAM-1, IL-6, GDF-15, tissue inhibitor of metalloproteinase (TIMP)-1, and tumor necrosis factor receptor (TNFR) I. Multivariable analysis indicated that only TNFRI, and TIMP-1 were predictive for PGF post HTx. Our results suggest that a pro-inflammatory phenotype is present in HTx recipients who develop PGF. Pre-HTx screening for circulating inflammatory mediators, such as serum TNFRI and TIMP-1,may identify patients at risk for PGF.

CITATION INFORMATION: Chatterjee D, Clerkin K, Rogers K, Mancini D, Naka Y, Takayama H, Takeda K, Colombo P, Vlad G, Vasilescu R, Levin B, Farr M, Restaino S, Zorn E. Primary Graft Failure following Cardiac Transplantation Is Associated with Elevated Pre-Transplant Levels of Pro-Inflammatory Factors. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress