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

Pretransplant cardiac troponin T(cTnT_pre) 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 cTnT_pre was associated with increased risk of posttransplant death/cardiac events independent of cardiovascular risk factors. Elevated cTnT_pre 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 (cTnT_3wks: HR = 5.575, CI 3.207-9.692, p < 0.0001; cTnT_1year: 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 cTnT_pre 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 cTnT_3wks 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.