CARDIAC TROPONIN-T - A NONINVASIVE MARKER FOR HEART-TRANSPLANT REJECTION

Background: Diagnosis of acute rejection remains a major concern in he art transplant recipients. Currently, endomyocardial biopsy is the gol d standard for detecting rejection. Given the risks and cost of endomy ocardial biopsy, a noninvasive marker for rejection would be ideal. Ca rdiac troponin T (cTnT) is an established marker of myocyte damage, an d a rat transplantation model of heart transplant rejection has sugges ted that cTnT may be of value in detecting rejection. Methods: The cTn T levels were measured in 90 transplant recipients (67 men and 23 wome n) at the time of endomyocardial biopsy. There were a total of 256 cTn T levels and 256 biopsy samples. The cTnT levels were compared by use of International Society of Heart and Lung Transplantation rejection g rades. Results: Only one of the 12 grade 3 biopsy specimens had a corr esponding elevated cTnT level. Of the 29 biopsy specimens with myocyte necrosis (grade 2 or Fade 3), three had a corresponding elevated cTnT . The cTnT levels were elevated during the first 1 to 2 months after t ransplantation. There was no correlation between ischemic time and cTn T levels. Conclusion: CTnT is an insensitive marker of acute rejection , both early and late after heart transplantation. Elevation of cTnT a fter transplantation does not seem to be directly related to ischemic time.