Value of Cardiac Troponin I and T for Selection of Heart Donors and as Predictors of Early Graft Failure 1

Potapov, Evgenij; Ivanitskaia, Ekaterina A.; Loebe, Matthias; Möckel, Martin; Müller, Christian; Sodian, Ralf; Meyer, Rudolf; Hetzer, Roland

doi:10.1097/00007890-200105270-00007

Cited by 69 publications

(50 citation statements)

References 36 publications

(22 reference statements)

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“…In the present study we showed elevated circulating plasma cardiac troponin-T levels, the sensitive marker of myocardial injury in heart donors after alcohol intoxication even when hemodynamic measurement showed no evidence of impaired contractile function. A clinical study showed cardiac troponin-T .0.1 mg/l in the serum of heart donors to be predictive of early impaired graft function after transplantation [20]. Previously with the same bolus of ethanol on rat significant elevation in cardiac troponin-T concentration was shown at 2.5 h and 6 h, but at 24 h, in contrast to our results, the levels were not significantly different from controls [21].…”

Section: Discussioncontrasting

confidence: 99%

Acute ethanol exposure increases the susceptibility of the donor hearts to ischemia/reperfusion injury after transplantation in rats

Li¹,

Korkmaz²,

Loganathan³

et al. 2013

Thorac cardiovasc Surg

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Background: Many donor organs come from youths involved in alcohol-related accidental death. The use of cardiac allografts for transplantation from donors after acute poisoning is still under discussion while acute ethanol intoxication is associated with myocardial functional and morphological changes. The aims of this work were 1) to evaluate in rats the time-course cardiac effects of acute ethanol-exposure and 2) to explore how its abuse by donors might affect recipients in cardiac pump function after transplantation.

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Section: Discussioncontrasting

confidence: 99%

Acute ethanol exposure increases the susceptibility of the donor hearts to ischemia/reperfusion injury after transplantation in rats

Li¹,

Korkmaz²,

Loganathan³

et al. 2013

Thorac cardiovasc Surg

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“…For these reasons, the value of donor cardiac troponin in organ selection has been an ongoing area of investigation. In a pivotal study, Potapov et al 6 found that donor troponin levels were 21 higher rates of rejection, 8 higher rates of graft failure, and death in infants. 7 In contrast, a more recent analysis from the California Transplant Donor Network, found no difference in 1-year survival between the 43 recipients of an organ with elevated serum troponin compared with the 96 patients with normal troponin levels.…”

Section: Discussionmentioning

confidence: 99%

“…15 The previous studies on outcomes of donors with elevated troponin suggested increased rates of graft failure. 6,7 To further examine the effect on graft function in a large number of patients through the UNOS database, we used a hard definition of PGF as death or retransplantation within 30 days because of graft failure (not related to rejection, infection, or surgical complications). 11 The results did not show an increased risk of PGF in hearts from donors with elevated troponin.…”

Section: Discussionmentioning

confidence: 99%

“…Early studies involving a small number of patients lent credence to this notion by showing that elevated troponin was associated with early graft dysfunction and rejection. [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%

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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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“…[47][48][49][50][51][52][53] Changes in catecholamine levels seen in massive subarachnoid hemorrhage and resulting in an increase in peripheral resistance may result in a sudden increase in myocardial work and oxygen consumption leading to myocardial infarction and subsequent elevation of cardiac troponin I and T. 54 Cadaveric donor levels of troponin I or T have been correlated with pathological findings of subendocardial myocytolysis, higher catecholamine requirements, and increased rates of recipient allograft rejection. [55][56][57][58] Endocrine considerations Dysfunction of the posterior pituitary is common with resultant low to undetectable levels of vasopressin manifest clinically as DI, and occurring in up to 90% of adult and pediatric organ donors. 16,23,[59][60][61] In contrast, variable deficiency of hormones regulated by the anterior pituitary including T3, thyroxine (T4), adrenocorticotropic hormone, thyroid stimulating hormone, and human growth hormone have been described.…”

Section: Temporal Considerationsmentioning

confidence: 99%

Medical management to optimize donor organ potential: review of the literature

Kutsogiannis

Pagliarello

Doig

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Over the past two decades, the demand for donor organs continues to outpace the number of organs available for transplantation. Parallel with this has been a change in the demographics of organ donors with an increase in older donors and donors with marginal organs as a proportion of the total organ donor pool. Consequently, efforts have been made to improve the medical care delivered to potential organ donors to improve the conversion rate and graft survival of available organs. The purpose of this literature review is to provide updated recommendations for the contemporary management of organ donors after the neurological determination of death in order to maximize the probability of recipient graft survival. Sources:A comprehensive review of the literature obtained through searches of MEDLINE/PubMed, and personal reference files.Principal findings: Contemporary management of the organ donor after neurological determination of death includes therapies to prevent the detrimental effects of the autonomic storm, the use of invasive hemodynamic monitoring and aggressive respiratory therapy including therapeutic bronchoscopy in marginal heart and lung donors, and the use of hormonal therapy including vasopressin, corticosteroids, triiodothyronine or thyroxine, and insulin for the pituitary failure and inflammation seen in brain dead organ donors. The importance of normalizing donor physiology to optimize all available organs is stressed. Conclusion:Aggressive hemodynamic and respiratory management of solid organ donors, coupled with the use of hormonal therapy improves the rate of conversion and graft survival in solid organ recipients. Objectif

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Value of Cardiac Troponin I and T for Selection of Heart Donors and as Predictors of Early Graft Failure 1

Abstract: Significantly higher cTnI and cTnT values were found in peripheral blood at the time of explantation in donors of hearts with subsequently impaired graft function and in not accepted donors. cTnI and cTnT are useful as additional parameters for heart donor selection.

Cited by 69 publications

References 36 publications

Acute ethanol exposure increases the susceptibility of the donor hearts to ischemia/reperfusion injury after transplantation in rats

Acute ethanol exposure increases the susceptibility of the donor hearts to ischemia/reperfusion injury after transplantation in rats

Donor Troponin and Survival After Cardiac Transplantation

Medical management to optimize donor organ potential: review of the literature

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