Donor Troponin and Survival After Cardiac Transplantation

Abstract

Background-Despite a limited supply of organs, only 1 in 3 potential donor hearts is accepted for transplantation. Elevated donor troponin levels have generally been considered a contraindication to heart transplantation; however, the data supporting this practice are limited. Methods and Results-We identified 10 943 adult (≥18 years) heart transplant recipients in the United Network of Organ Sharing (UNOS) database with preserved donor left ventricular ejection fraction (≥50%) and where peak donor troponin I values were available. When analyzed as a continuous variable, there was no association between peak donor troponin levels and recipient mortality up to 1 year follow-up in unadjusted (hazards ratio, 0.999; 95% confidence interval, 0.997-1.002; P=0.856) and adjusted Cox models (hazards ratio, 1.000; 95% confidence interval, 0.997-1.002; P=0.950). Next, we divided the entire cohort into 3 groups based on donor troponin I values: <1 ng/mL (n=7812), 1 to 10 ng/mL (n=2770), and >10 ng/mL (n=361). Using unadjusted and adjusted Cox models and Kaplan-Meier analysis, there was no significant difference in recipient mortality at 30 days, 1 year, 3 years, or 5 years between the 3 groups. Similarly, cardiac allograft vasculopathy up to 5 years and primary graft failure up to 30 days of follow-up post transplant did not differ between the 3 donor troponin groups. The median length of hospital stay post transplant was also similar across groups. Conclusions-Elevated donor troponin I levels in the setting of preserved left ventricular ejection fraction were not associated with intermediate-term mortality, cardiac allograft vasculopathy, or primary graft failure rates in hearts accepted for transplantation. This finding could help expand the donor pool. (Circ Heart Fail. 2016;9:e002909.

Transplant Center Variability in Organ Offer Acceptance and Mortality Among US Patients on the Heart Transplant Waitlist

“…As such, the lack of standardization of practice and acceptable range of offer acceptance rates appear to permit such variability. In addition, reasons for declining organ offers vary across centers, but resource limitation and risk aversion may help explain why centers elect to decline extended-criteria donor heart allografts . We noted that, compared with lower acceptance centers, higher acceptance centers accepted a larger proportion of first-rank offers from donors with increased risk, including those aged 40 years or older and those with PHS-determined increased risk of infectious diseases.…”

Donor Cardiac Troponin for Prognosis of Adverse Outcomes in Cardiac Transplantation Recipients: a Systematic Review and Meta-analysis

“…From 5 studies 13,27,30,33,37,38,41 involving 12 501 patients, we found no association between elevated donor troponin and 1-y mortality; the result was not statistically significant (OR, 0.97; 95% CI, 0.75-1.25) (Figure 3B). There was not significant interstudy statistical heterogeneity (I 2 statistic 28%).…”

Plasma Levels of SERCA2a as a Noninvasive Biomarker of Primary Graft Dysfunction After Heart Transplantation

“…26 Elevated levels of cardiac troponin in donor serum have not demonstrated an association with PGD. 27 NT-proBNP in donor serum could predict poor cardiac performance in the recipient. 28 Actually, some studies have highlighted the role of serum exosome proteomic analysis in the recipient as a potential biomarkers for PGD.…”