Impact of Cardiac Troponin I as a Predictor of Graft Failure in Selection of Heart Donors

Objectives: Donor selection remains a critical yet poorly standardized aspect of heart transplantation (HTx). The aim of this study was to determine whether elevated donor cardiac serum marker troponin I (cTnI) is associated with graft failure after HTx.

Methods: Between January 1999 and August 2013, cTnI serum concentration was measured in samples collected from 161 consecutive potential donors. The cTnI levels were normal in 116 donors (72.0%) and elevated in 45 donors (28%). Each study subject was classified as having elevated cTnI if any level exceeded 0.3 ng/mL.

Results: The estimated left ventricular ejection fraction on the initial donor echocardiogram was similar in both groups (67% ± 14% versus 63% ± 12%; p = 0.09). Donors with elevated cTnI levels did not require higher doses of inotropic drugs before transplantation and had similar hemodynamic profiles compared with donors with normal cTnI levels. The mean allograft cold ischemic times also were similar between the groups (211 ± 44 min versus 199 ± 53 min; p = 0.14). Postoperative, recipients of grafts from donors with elevated cTnI levels had significantly higher incidences of postoperative acute renal injury, longer ventilation time, and intensive care unit stay. Furthermore, the 30-days mortality (22.2% versus 8.6%; p = 0.03) and the 1-year mortality (46.7% versus 17.2%; p = 0.0002) were significantly higher recipients of grafts from donors with elevated cTnI levels.

Conclusions: Elevated cTnI serum concentration in donors was independent prognostic marker of impaired graft function after HTx. Its use as additional parameter may improve heart donor selection.