Serum troponin Ic values in organ donors are related to donor myocardial dysfunction but not to graft dysfunction or rejection in the recipients

Boccheciampe, Nicolas; Audibert, G.; Rangeard, O.; Charpentier, Claire; Perrier, Jean‐François; Lalot, Jean-Marc; Voltz, C.; Strub, P.; Loos-Ayav, Carole; Meistelman, Claude; Mertès, Paul-Michel; Longrois, Dan

doi:10.1016/j.ijcard.2007.12.006

Cited by 26 publications

(26 citation statements)

References 17 publications

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“…Among these are cardiac troponins, markers of myocardial injury or infarction and an important prognostic index in ischaemic heart disease and advanced heart failure [5]. Elevated troponins have been correlated with donor heart dysfunction and may predict adverse recipient outcome, being associated in some studies with increased risk of early graft failure and increased rates of inotrope requirement post-transplantation and post-transplant rejection [6][7][8][9][10] However, this association remains controversial as equivalent outcomes have been achieved in other studies with no increased risk of rejection [11][12][13]. The objectives of this study were to evaluate the prevalence of cardiac troponin-I (cTnI) elevation in heart donors, its relationship to donor heart function and time from coning, its predictive value of donor heart suitability and posttransplant recipient outcome in a prospective study.…”

Section: Introductionmentioning

confidence: 99%

Donor cardiac troponin-I: a biochemical surrogate of heart function☆☆☆

Venkateswaran¹,

Ganesh²,

Thekkudan³

et al. 2009

European Journal of Cardio-Thoracic Surgery

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Section: Introductionmentioning

confidence: 99%

Donor cardiac troponin-I: a biochemical surrogate of heart function☆☆☆

Venkateswaran¹,

Ganesh²,

Thekkudan³

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…Although the precise reason for these discrepant findings is not clear, it should be noted that all previous analysis were limited by small sample size, single-center experience, and conducted in a previous era of management. 9 This last consideration is important because the improvement in survival during the past 2 to 3 decades after heart transplantation 1 Therefore, it is possible that current postoperative management practices have allowed us to overcome any potential short-term risk, elevated troponin may have conveyed. Alternatively, as UNOS does not have dedicated reporting on PGF, granular detail on the perioperative course such as differences in increased or extended use of inotropes and the need for temporary mechanical circulatory support after transplant may have been missed.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Subsequent studies, similarly limited by sample size, have demonstrated conflicting results. 4,9,10 Ultimately, there are no definitive data to guide the decision whether to accept or reject an organ solely on the basis of elevated troponin levels.…”

mentioning

confidence: 99%

Donor Troponin and Survival After Cardiac Transplantation

Madan

Saeed

Shin

et al. 2016

Circ: Heart Failure

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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.

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“…A variety of potential biomarkers have been examined, but studies have yielded contradictory results, and the usefulness of biomarkers for this indication remains controversial. The most commonly studied biomarker is troponin (either troponin I or T), which is a highly sensitive marker of myocyte necrosis [29][30][31][32]. Studies in patients suffering subarachnoid haemorrhage or Takotsubo cardiomyopathy have demonstrated a significant association between serum troponin levels and myocardial dysfunction.…”

Section: Biomarkers Of Primary Graft Dysfunctionmentioning

confidence: 99%

“…However, these same studies have also shown that myocardial dysfunction is reversible, even in the presence of elevated troponin levels [33,34]. Similarly, multiple studies in potential heart donors have demonstrated a significant correlation between the level of troponin I (or T) in donor serum and donor heart dysfunction, although the relationship between donor troponin levels and PGD has been inconsistent among studies [29][30][31][32]. Some studies have reported that donor troponin levels were predictive of PGD, whereas others found this not to be the case.…”

Section: Biomarkers Of Primary Graft Dysfunctionmentioning

confidence: 99%

Primary Graft Dysfunction After Heart Transplantation

et al. 2014

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Primary graft dysfunction (PGD) is a lifethreatening complication of heart transplantation that presents as left, right, or biventricular dysfunction occurring within the first 24 hours of transplant surgery for which there is no identifiable secondary cause. Myocardial injury caused by acute catecholamine toxicity and the release of multiple proinflammatory mediators in the donor, followed by ischaemiareperfusion injury sustained during retrieval, have been considered the predominant pathogenetic processes leading to PGD. Donor, recipient, and procedural factors contribute to the development and severity of the clinical syndrome. The changing donor and recipient characteristics over the last two decades, particularly the increasing donor and recipient age, have led to heightened risk of PGD. PGD is graded from mild to severe depending on the extent of circulatory support that is required to maintain haemodynamic stability and vital organ function. While advances in acute mechanical support devices have improved the outlook for patients with PGD, the rate of mortality remains high for those with severe PGD, reaching 40 %. Potential approaches to preventing or minimising the severity of PGD include optimising donor management, donor heart preservation, and donor/recipient matching.

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Serum troponin Ic values in organ donors are related to donor myocardial dysfunction but not to graft dysfunction or rejection in the recipients

Cited by 26 publications

References 17 publications

Donor cardiac troponin-I: a biochemical surrogate of heart function☆☆☆

Donor cardiac troponin-I: a biochemical surrogate of heart function☆☆☆

Donor Troponin and Survival After Cardiac Transplantation

Primary Graft Dysfunction After Heart Transplantation

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