Procalcitonin, a donor-specific predictor of early graft failure-related mortality after heart transplantation.

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.

Value of cardiac troponin I and T for selection of heart donors and as predictors of early graft failure.

BACKGROUND: Cardiac troponin I and T (cTnI and cTnT) are sensitive and specific markers of myocardial damage. We evaluated them for the selection of heart donors and as predictors of early graft failure after heart transplantation. METHODS: cTnI, cTnT, myoglobin, and creatine kinase (CK) levels and its isoenzyme MB (CKMB) activity and mass were measured in serum samples immediately before opening the pericardium from 126 consecutive brain-dead multi-organ donors over 10 years of age inspected by our harvesting team. Donors with serum creatinine >2.0 mg/dL (n=6) were excluded from the analysis. Donors for high-urgency status recipients (n=2) were also excluded. The remaining donors were retrospectively divided into three groups: group I (n=68), grafts with good function; group II (n=11), grafts with impaired function; and group III (n=39), grafts not accepted for transplantation. RESULTS: No differences in donor and recipient characteristics were found among the groups. The mean values of cTnI (0.36+/-0.88 microg/L, 4.45+/-3.28 microg/L, and 3.02+/-7.88 micog/L, respectively) and cTnT (0.016+/-0.029 microg/L, 0.134+/-0.114 microg/L, and 0.123+/-0.245 microg/L, respectively) were lower in group I when compared with groups II or III (cTnI: P<0.0001, P=0.018; cTnT: P<0.0001, P=0.012). The cTnI value was higher in group II compared with group III (P=0.023). The cTnT values were similar in groups II and III. A cTnI value >1.6 microg/L as a predictor of early graft failure had a specificity of 94%, and a cTnT value of >0.1 microg/L had a specificity of 99%. The odds ratio for the development of acute graft failure after heart transplantation was 42.7 for donors with cTnI >1.6 microg/L and 56.9 for donors with cTnT >0.1 microg/L. No differences of myoglobin, CKMB activity, or CKMB/CK ratio were found among the groups. CONCLUSIONS: Significantly higher cTnI and cTnT values were found in peripheral blood at the time of explantation in donors of hearts with subsequently impaired graft function and in not accepted donors. cTnI and cTnT are useful as additional parameters for heart donor selection.

Development of pulmonary arteries after central aortopulmonary shunt in newborns.

BACKGROUND: Central shunt (CS) is frequently used to treat diminished pulmonary blood flow in newborns. We analyzed the impact of CS on the growth of the pulmonary arteries (PAs). METHODS: Twenty-two consecutive newborns underwent a CS procedure. In 15 newborns the preoperative angiograms and angiograms taken before undergoing anatomic or hemodynamic correction procedures were analyzed. The patients were divided retrospectively into two groups by the size of the PA in the preoperative angiogram: group I, patients with PAs more than 4 mm (n = 10), group II, PAs 4 mm or less (n = 5). To compare the development of the PAs in the groups, the Nakata index, McGoon ratio, and lower lobe indices were calculated from angiograms. RESULTS: The indices were significantly higher in group I before CS, but no differences was found between the groups before anatomic or hemodynamic correction. The postoperative Nakata indices and the McGoon ratios in the groups were higher when compared with preoperative values (group I, p = 0.037 and p = 0.013; group II, p = 0.043 and p = 0.043, respectively). The significant increase of the lower lobe indices only in group II (p = 0.043) suggests faster growth of the PA in this group. CONCLUSIONS: Optimal diameters of the CS promote growth of the PAs, which was confirmed by the increased Nakata and McGoon indices. The benefit in smaller PAs is greater.

[Stimulation of ribonuclease activity under the influence of nitrosoethylurea]. / Stimuliatsiia aktivnosti ribonukleazy pod vliianiem nitrozoétilmocheviny

Nutrosoethyl urea-induced activation of alkaline ribonuclease was accelerated with the increase of the temperature from 22 to 32 degrees C. The reaction rate at 32 degrees C was more than 8 fold increased as compared with the control. Further increase of temperature to 42 degrees C decreased the stimulating effect of nitrosoethyl urea. The effect observed may be taken into consideration when studying a molecular mechanism of the effect of chemical mutagens on cell metabolism.

[Effect of nitrosomethylurea and 1,4-bis-diazoacetylbutane on alkaline ribonuclease activity]. / Vliianie nitrozometilmocheviny i 1,4-bis-diazoatsetilbutana na aktivost' shchelochnoi ribonukleazy

It was shown that at 37 degrees C nitrosomethylurea causes an 8-fold increase (as compared to the normal) of the activity of alkaline ribonuclease. 1,4-Bis-diazoacetylbutane also activated alkaline ribonuclease at 37 degrees C. A dependence of the effect of chemical mutagens studied on the activity of alkaline ribonuclease on their concentration was observed. The activation of ribonuclease by NMU and DAB affords a possibility to understand the molecular mechanisms of the action of chemical mutagens on the metabolism.

[Stimulation of desoxyribonuclease activity by nitrosomethylurea]. / Stimuliatsiia aktivnosti dezoksiribonukleazy pod vliianiem nitrozometilmocheviny.

It is shown in vitro in model experiments under biological conditions of pH and temperature, the pancreatic DNase activation by nitrosomethylurea depends on both mutagen concentration and temperature. The spectrophotometric observation revealed the formation of mutagen-enzyme complex which resulted from the interaction of the mutagen molecules with DNase macromolecules.