Original clinical science
Troponin I levels from donors accepted for pediatric heart transplantation do not predict recipient graft survival

https://doi.org/10.1016/j.healun.2011.02.011Get rights and content

Background

Troponin I is often obtained during the evaluation of a potential transplant donor heart. It is not clear whether elevations in donor troponin I levels predict adverse outcomes and should thus preclude acceptance of a donor heart. This study examined whether troponin I levels from donors accepted for pediatric heart transplantation predicted graft failure.

Methods

Deidentified data on heart transplants performed in recipients aged < 21 years between April 2007 and April 2009 was provided by the Organ Procurement and Transplantation Network. Donor troponin I level and recipient outcomes, including survival without retransplantation (graft survival), were examined for statistical correlation.

Results

Overall graft survival in 839 heart transplants was 81% at 2 years. At least 1 troponin I level was recorded in 657 donors before transplant, with a median value of 0.1 ng/ml (range, 0–50 ng/ml). Troponin I level and graft status were not correlated (p = 0.74). A receiver operating characteristic curve showed no association between troponin I and graft status (area under the curve, 0.51; p = 0.98). Graft survival did not differ significantly (p = 0.60) among quartiles of troponin I levels (<0.04, 0.04–<0.1, 0.1–<0.35, ≥0.35 ng/ml). A troponin I level ≥ 1 ng/ml was found in 74 transplanted donor hearts; graft survival was not associated with troponin I ≥ 1 (80%) vs < 1 (80%) at 2 years (p = 0.93). Troponin I values were not associated with post-transplant hospital length of stay (r = –0.06; p = 0.10).

Conclusions

In donor hearts accepted for pediatric heart transplantation, troponin I elevation before procurement is not associated with increased graft failure. The significance of elevated troponin I levels, which occurs in many heart donors, remains unclear and should therefore be considered in the context of other clinical information.

Section snippets

Data collection and study population

The United Network for Organ Sharing (UNOS) provided deidentified data for the 847 heart transplants, which took place between April 1, 2007, and April 30, 2009 in recipients aged ≤ 21 years old. Follow-up was current through December 11, 2009. Within this period, 8 recipients received 2 transplants, and the second transplant was excluded from analysis. The troponin I levels recorded in this data set represent the last available troponin I level reported to UNOS from a donor before

Results

Of 839 heart transplants analyzed in recipients aged ≤ 21 years old, a troponin I value was recorded from the donor before organ procurement in 657. Overall graft survival at 2 years was 81%. There was no difference in graft status between those with and those without a measured donor troponin I level (p = 0.75). For those with a donor troponin I measurement, there was no correlation between donor troponin I level and graft status (p = 0.74; Figure 1). The troponin I level was ≥ 1 ng/ml in 74

Discussion

In this retrospective analysis of all pediatric heart transplant recipients in the UNOS data registry for whom there are recorded donor cardiac troponin I levels from April 2007 to April 2009, no correlation was found between donor troponin I levels and graft survival after transplantation. Indeed, grafts from donors with even the highest pre-procurement troponin I levels demonstrated survivability on par with the rest of the data set. In addition, we demonstrate that donor pre-procurement

Disclosure statement

This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the

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