Cardiac Troponin T Risk Stratification Model Predicts All-Cause Mortality Following Kidney Transplant

Christine Firth, Fadi Shamoun, Stephen Cha, Nan Zhang, Salma Patel, Paul Wennberg, Hatem Amer, Hani Wadei, Raymond Heilman, Mira Keddis

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Abstract

Background: We evaluated the role of increased cardiac troponin T (cTnT), vascular, and cardiac diseases in predicting 5 and 10-year all-cause mortality after kidney transplantation. Methods: We reviewed a cohort of 764 kidney transplant recipients and analyzed pertinent cardiovascular risk factors at the time of transplant evaluation. Proportional hazards regression analysis with bootstrapping method was utilized to provide a risk stratification score for mortality. Results: Mean age was 58.8 years (SD 12.1) and median follow-up was 7.0 years (range 1 day to 18.0 years). Fifty-four percent of patients (n = 415) had cTnT measured (median 0.02 ng/mL, range 0.01-4.91). Fifty-three percent (n = 407) had vascular disease, 59% (n = 448) had diabetes, and 44% (n = 336) had cardiac disease pre-transplant. Sixty percent (n = 460) required dialysis. Older age, increased cTnT, pre-transplant vascular and cardiac diseases predicted mortality in multivariate analysis. We derived 2 scoring systems with and without cTnT - the ACV and ACTV scores (age, cardiac disease, elevated cTnT, and vascular disease) - as predictors of mortality after kidney transplant. Point assignments were: age 60-69 years (1), age ≥70 years (2), cardiac disease (1), cTnT ≥0.04 ng/mL (1), and vascular disease (1). Both scoring systems significantly predicted mortality. The ACTV score better delineated risk stratification across score levels (0-2, 3-4, and 5 points). Conclusions: We developed a risk schema predictive of all-cause mortality after kidney transplant in a derivation cohort. The ACTV score, including an elevated cTnT, provided superior prediction compared to a scoring system without cTnT. Further studies to validate these findings are needed.

Original languageEnglish (US)
Pages (from-to)242-250
Number of pages9
JournalAmerican Journal of Nephrology
DOIs
StateAccepted/In press - Jan 1 2018

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ASJC Scopus subject areas

  • Nephrology

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Firth, C., Shamoun, F., Cha, S., Zhang, N., Patel, S., Wennberg, P., Amer, H., Wadei, H., Heilman, R., & Keddis, M. (Accepted/In press). Cardiac Troponin T Risk Stratification Model Predicts All-Cause Mortality Following Kidney Transplant. American Journal of Nephrology, 242-250. https://doi.org/10.1159/000493273