Elevated donor plasminogen activator inhibitor-1 levels and the risk of primary graft dysfunction

Clin Transplant. 2018 Apr;32(4):e13210. doi: 10.1111/ctr.13210. Epub 2018 Feb 23.

Abstract

Primary graft dysfunction (PGD) following lung transplantation is associated with elevated recipient plasma levels of plasminogen activator inhibitor-1 (PAI-1) and the receptor for advanced glycation end products (RAGE). However, the significance of these biomarkers in the donor plasma is uncertain. We hypothesized that elevated donor plasma levels of PAI-1 and RAGE would be associated with recipient PGD. We carried out a prospective unmatched case-control study of double-lung transplant recipients between May 2014 and September 2015. We compared donor plasma levels of PAI-1 and RAGE using rank-sum tests and t tests, in 12 recipients who developed PGD grade 2 or 3 within 72 hours postoperatively with 13 recipients who did not. Recipients who developed PGD had higher donor plasma levels of PAI-1 than recipients who did not (median 2.7 ng/mL vs 1.4; P = .03). Recipients with PGD also had numerically higher donor plasma levels of RAGE than recipients without PGD, although this difference did not achieve statistical significance (median 1061 pg/mL vs 679; P = .12). Systemic inflammatory responses in the donor, as reflected by elevated plasma levels of PAI-1, may contribute to the risk of developing PGD. Rapid biomarker assessment of easily available plasma samples may assist in donor lung selection and risk stratification.

Keywords: biomarker; donor; lung transplantation; plasminogen activator inhibitor 1; primary graft dysfunction.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Biomarkers / blood*
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Diseases / surgery*
  • Lung Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Pilot Projects
  • Plasminogen Activator Inhibitor 1 / blood*
  • Postoperative Complications / blood
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / etiology
  • Primary Graft Dysfunction / blood
  • Primary Graft Dysfunction / diagnosis*
  • Primary Graft Dysfunction / etiology
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Tissue Donors / statistics & numerical data*

Substances

  • Biomarkers
  • Plasminogen Activator Inhibitor 1
  • SERPINE1 protein, human