Elevated Cardiac Troponin to Detect Acute Cellular Rejection After Cardiac Transplantation: A Systematic Review and Meta-Analysis

Abstract

Cardiac troponin is well known as a highly specific marker of cardiomyocyte damage, and has significant diagnostic accuracy in many cardiac conditions. However, the value of elevated recipient troponin in diagnosing adverse outcomes in heart transplant recipients is uncertain. We searched MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library from inception until December 2020. We generated summary sensitivity, specificity, and Bayesian areas under the curve (BAUC) using bivariate Bayesian modelling, and standardised mean differences (SMDs) to quantify the diagnostic relationship of recipient troponin and adverse outcomes following cardiac transplant. We included 27 studies with 1,684 cardiac transplant recipients. Patients with acute rejection had a statistically significant late elevation in standardised troponin measurements taken at least 1 month postoperatively (SMD 0.98, 95% CI 0.33–1.64). However, pooled diagnostic accuracy was poor (sensitivity 0.414, 95% CrI 0.174–0.696; specificity 0.785, 95% CrI 0.567–0.912; BAUC 0.607, 95% CrI 0.469–0.723). In summary, late troponin elevation in heart transplant recipients is associated with acute cellular rejection in adults, but its stand-alone diagnostic accuracy is poor. Further research is needed to assess its performance in predictive modelling of adverse outcomes following cardiac transplant.Systematic Review Registration: identifier CRD42021227861

Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing

“…The role of post-transplant Tn levels in assessing the presence of cardiac transplant rejection is less clear. In a recent meta-analysis of 27 studies with 1684 heart transplant recipients, patients with acute rejection had a statistically significant late elevation in Tn measurements taken at least 1 month postoperatively (the analysis included both conventional and hs-Tn assays and both TnI and TnT assays) [ 125 ]. However, the pooled diagnostic accuracy was poor, with a sensitivity of 41% and specificity of 76%, suggesting that Tn is insufficient for use as a stand-alone diagnostic tool.…”

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