Biomarkers and Donor Selection in Heart Transplantation

• Published in: Transplantation proceedings 2019-07, Vol.51 (6), p.1673-1678
• Main Authors: Vorlat, Anne, De Hous, Nicolas, Vervaecke, Alexander J., Vermeulen, Tom, Van Craenenbroeck, Emeline, Heidbuchel, Hein, Rodrigus, Inez, Van Donink, Walter, Ancion, Arnaud, Van Cleemput, Johan, Van Hoof, Viviane O., Claeys, Marc J.
• Format: Article
• Language: English
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2019.04.041

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. 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. 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/m2) 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. 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. •The selection of donor hearts is critical in the success of heart transplantation.•Risk stratification of donor hearts is based on clinical and echocardiographic data.•Donor BNP provides incremental information on donor heart status.•Donor BNP provides information on early post-transplant performance.•ST2 appears to have no value in the evaluation of potential heart donors.