Preoperative recipient cytokine levels are associated with early lung allograft dysfunction

Primary graft dysfunction (PGD) is a morbid complication after lung transplant (LTx). Recipient before and after cytokine and chemokine profiles may be associated with a recipient's propensity to have PGD.

Serum samples were obtained from adult (more than 17 years old) primary LTx recipients (2002 to 2007) at two time points: (1) pre-reperfusion of transplanted lungs, and (2) within 24 hours after reperfusion. Interleukin (IL)-6, IL-8, IL-10, chemokine ligand (CCL)-2, and matrix metalloproteinase (MMP)-9 levels were determined. A PaO2/FiO2 ratio less than 300 at 48 hours (International Society for Heart and Lung Transplantation PGD grade 2 or more) was used to stratify patients. Follow-up was obtained through August 2009. Cytokine levels at both time points and the change in levels were assessed for association with PGD grade 2 or more. Outcomes and clinical characteristics were analyzed.

Of 28 patients, 8 (28.6%) had PGD grade 2 or more. Median follow-up was 23 months (interquartile range, 16 to 31). Demographics, clinical data, and pre-LTx diagnoses did not differ between the groups. Patients who had PGD grade 2 or more had higher baseline levels of IL-10, IL-8, IL-6, and CCL-2 (all p<0.05). Within 24 hours, PGD grade 2 or more patients had higher IL-10 (p=0.02) and CCL-2 (p=0.04) levels. The PGD grade 2 or more patients were more likely to have had cardiopulmonary bypass during LTx (p=0.002) and blood products administered: platelets (p=0.004), plasma (p=0.05), and packed red blood cells (p=0.03)]. The PGD grade 2 or more patients had longer length of stay, duration of mechanical ventilation, and total intensive care unit days.

Higher before and after transplant cytokine/chemokine levels were found in LTx recipients who subsequently had PGD grade 2 or more. Our study demonstrates that the recipient's inflammatory state at the time of LTx may impact early allograft function. That could represent a potential target for pretransplant pharmacologic intervention.