Donor cardiac troponin T: A marker to predict heart transplant rejection

Background. Noninvasive methodologies have shown poor sensitivity in predic ting rejection when compared to serial endomyocardial biopsies. We studied the potential role of donor blood troponin T (Tn-T) as a marker for predict ing heart transplant rejection. Methods. Blood cardiac Tn-T was measured from 16 heart donors. Transplant r ejection and cardiac function in the recipients were monitored for 1 year. Results. When data were analyzed based on donor blood Tn-T levels, 6 patien ts who received hearts from donors with low Tn-T (<0.45 +/- 0.1 ng/mL) show ed no rejection, and patients whose hearts came from donors with higher Tn- T (6.01 +/- 0.81 ng/mL) developed episodes of high-grade rejection (3A) wit hin 38.5 +/- 2.1 days after transplantation. Eight patients who received he arts from donors with intermediate levels of Tn-T (3.57 +/- 0.55 ng/mL) sho wed mild rejection (grade 1). All recipients had qualitatively normal left ventricular systolic function by serial echocardiography. The mean donor is chemic time was 169 +/- 47 minutes. Conclusions. The quality of the donor heart is an important prognostic fact or in heart transplantation. It may be possible to identify severely damage d donor organs before transplantation and avoid their use or to develop mor e aggressive strategies for reducing recurrent acute rejection episodes in high-risk patients. (C) 1998 by The Society of Thoracic Surgeons.