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Updated: Jul 12, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Procalcitonin, a donor-specific predictor of early graft failure-related mortality after heart transplantation
F D Wagner1, B Jonitz, E V Potapov
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. wagner@dhzb.de
Insights
Elevated procalcitonin (PCT) levels in heart donors may predict early graft failure. A PCT level above 2 ng/mL in donors is associated with increased mortality risk in heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Immunology
- Biomarker Discovery
Background:
- Donor-specific markers for predicting heart transplant outcomes are currently unknown.
- Procalcitonin (PCT) is associated with inflammation and organ perfusion but its role in heart donors is unstudied.
- This study investigates PCT as a potential predictor of early graft failure after heart transplantation (HTx).
Purpose of the Study:
- To evaluate procalcitonin (PCT) as a predictor of early graft failure-related mortality after heart transplantation (HTx).
Main Methods:
- Serum concentrations of PCT and C-reactive protein (CRP) were measured in 81 brain-dead multi-organ heart donors.
- Donors were retrospectively divided into groups based on recipient 30-day mortality post-HTx.
- Receiver operating characteristic (ROC) curves were used to assess predictive performance.
Main Results:
- PCT demonstrated a higher area under the ROC curve (0.71) compared to CRP (0.64) for predicting graft failure-related mortality.
- A PCT level >2 ng/mL predicted graft failure-related mortality with 95.8% specificity and 50.0% sensitivity.
- Donors with PCT >2 ng/mL had a significantly increased odds ratio for graft failure-related mortality (adjusted OR 43.8).
Conclusions:
- A procalcitonin (PCT) level exceeding 2 ng/mL in cardiac donors at explantation is a potential predictor of early graft failure-related mortality.
- This finding may aid in donor selection and improve outcomes for heart transplant recipients.
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.
