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Published on: November 2, 2019
Factors associated with cardiac allograft vasculopathy after heart transplantation
Wioletta Szczurek-Wasilewicz1, Michał Hawranek2, Michał Skrzypek3
1Department of Heart and Vessels Diseases, Silesian Center for Heart Diseases, Zabrze, Poland.
Insights
Cardiac allograft vasculopathy (CAV) is a significant risk after heart transplantation. Higher ST2 and lower IL-33 levels, along with donor age and time post-transplant, are key indicators for detecting CAV.
Area of Science:
- Cardiology
- Transplantation Immunology
- Biomarker Discovery
Background:
- Cardiac allograft vasculopathy (CAV) poses a major threat to long-term survival following heart transplantation (HT).
- Identifying reliable predictors for CAV is crucial for patient management and improving outcomes.
Purpose of the Study:
- To determine factors associated with the detection of CAV in patients after heart transplantation.
- To evaluate the prognostic power of Interleukin-33 (IL-33) and Suppression of Tumorigenicity 2 (ST2) in predicting CAV.
Main Methods:
- Analysis of 299 heart transplant recipients between 2016-2018.
- Measurement of serum IL-33 and ST2 concentrations using ELISA.
- Multivariable logistic regression and ROC curve analysis to identify risk factors and assess prognostic power.
Main Results:
- CAV was detected in 47.5% of patients.
- Independent risk factors for CAV included higher IL-33 and ST2 serum concentrations, older donor age, larger left ventricular diastolic dimension (LVDD), and longer time from HT.
- IL-33 and ST2 demonstrated good discriminatory power (AUC=0.779 and 0.784), with the IL-33/ST2 score showing excellent power (AUC=0.863).
Conclusions:
- Serum IL-33, ST2 levels, donor age, LVDD, and time from HT are independently associated with CAV.
- The IL-33/ST2 score is a highly effective tool for detecting CAV in heart transplant recipients.
Introduction:
Cardiac allograft vasculopathy (CAV) is a major threat to long-term survival after heart transplantation (HT).
Aim:
To determine factors associated with CAV detection in patients after HT.
Material And Methods:
We analyzed 299 consecutive patients after HT who underwent routine visits at our institution between 2016 and 2018. Human interleukin 33 (IL-33) and suppression of tumorigenicity 2 (ST2) were measured by sandwich enzyme-linked immunosorbent assay with a commercially available kit (Human ST-2 and IL-33 ELISA, SunRedBio Technology Co, Ltd, Shanghai, China).
Results:
The patients' median age was 59.00 years, and 74.2% were men. The frequency of CAV was 47.5%. Multivariable logistic regression analysis showed that IL-33 (odds ratio (OR) = 1.044 (1.029-1.059), p < 0.001) and ST2 (OR = 1.061 (1.040-1.083), p < 0.001) serum concentrations, donor age (OR = 1.046 (1.009-1.085), p = 0.015), left ventricular diastolic dimension (LVDD) (OR = 1.081 (1.016-1.149), p = 0.013), and time from HT to blood collection (OR = 1.256 (1.151-1.371), p < 0.001) were independent risk factors for CAV. The area under the receiver operating characteristics curve (AUC) indicated good prognostic power of IL-33 and ST2 concentrations (AUC = 0.779 and AUC = 0.784, respectively) and excellent prognostic power of the IL-33/ST2 score (AUC = 0.863).
Conclusions:
Lower IL-33 and higher ST2 serum concentrations, as well as older donor age, larger LVDD and longer time from HT to blood collection, are independently associated with CAV. IL-33 and ST2 have good discriminatory power and the IL-33/ST2 score has excellent strength for detecting CAV.
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