Cardiac troponin T before and after kidney transplantation: Determinants and implications for posttransplant survival

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Pretransplant cardiac troponin T(cTnTpre) is a significant predictor of survival postkidney transplantation. We assessed correlates of cTnT levels pre- and posttransplantation and their relationship with recipient survival. A total of 1206 adult recipients of kidney grafts between 2000 and 2010 were included. Pretransplant cTnT was elevated (≥0.01 ng/mL) in 56.4%. Higher cTnTpre was associated with increased risk of posttransplant death/cardiac events independent of cardiovascular risk factors. Elevated cTnTpre declined rapidly posttransplant and was normal in 75% of recipients at 3 weeks and 88.6% at 1 year. Elevated posttransplant cTnT was associated with reduced patient survival (cTnT3wks: HR = 5.575, CI 3.207-9.692, p < 0.0001; cTnT1year: 3.664, 2.129-6.305, p < 0.0001) independent of age, diabetes, pretransplant dialysis, heart disease and allograft function. Negative/positive predictive values for high cTnT 3wks were 91.4%/50% respectively. Normalization of cTnT posttransplant was associated with reduced risk. Variables related to elevated cTnT posttransplant included pretransplant diabetes, older age, time on dialysis, high cTnTpre and lower graft function. Patients with delayed graft function and those with GFR < 30 mL/min at 3 weeks were more likely to have an elevated cTnT3wks and remained at high risk. When allografts restore sufficient kidney function cTnT normalizes and patient survival improves. Lack of normalization of cTnT posttransplant identifies a group of individuals with high risk of death/cardiac events. The authors assess changes in cardiac troponin T levels after kidney transplantation and conclude that these levels drop rapidly after transplantation, their reduction is associated with decline in cardiovascular risk/death, and their change is dependent, in part, on allograft function.

Original languageEnglish (US)
Pages (from-to)406-414
Number of pages9
JournalAmerican Journal of Transplantation
Volume13
Issue number2
DOIs
StatePublished - Feb 1 2013

Keywords

  • Cardiac troponin
  • cardiovascular morbidity
  • kidney transplantation
  • survival

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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