Department of Nephrology and Transplantation, University Hospitals Gasthuisberg, Leuven, Belgium.
Transplantation. 2010 Feb 15;89(3):341-6. doi: 10.1097/TP.0b013e3181bc405e.
Patients on the renal transplant waiting list and renal transplant recipients have an increased risk of premature cardiovascular (CV) disease and death.
We performed a prospective observational study in 331 kidney or kidney-pancreas transplant recipients to test whether Troponin I (TnI), determined at time of engraftment, can help to identify patients at risk for a major adverse cardiac event (MACE) in the immediate postoperative period. Logistic regression analysis was used to test if pretransplant TnI is a predictor of MACE within 3 months after transplantation.
Eleven patients (3.3%) developed a MACE during the first 2 weeks after transplantation. In patients with a CV history (23.6%), the incidence of MACE increased to 13.4%. In univariate analysis, age (odds ratio [OR] 1.062, P=0.04), TnI (OR 1.12, P=0.0042), HbA1c (OR 1.879, P=0.0076), and CV history (absent vs. present OR 0.027, P=0.0006) were associated with MACE. TnI remained an independent predictor after adjusting for every other significant variable. When we restricted the analysis to patients with a CV history, TnI was the only statistically significant variable associated with MACE.
Elevated TnI, immediately pretransplant, is an independent predictor of MACE in the immediate posttransplant period, particularly in patients with CV history.
肾移植候补患者和肾移植受者发生心血管（CV）疾病和死亡的风险增加。
我们对 331 名肾或肾胰脏移植受者进行了前瞻性观察研究，以检验移植时确定的肌钙蛋白 I（TnI）是否有助于识别术后早期发生重大不良心脏事件（MACE）的高危患者。采用逻辑回归分析来检验移植前 TnI 是否是移植后 3 个月内发生 MACE 的预测因子。
11 例患者（3.3%）在移植后前 2 周内发生 MACE。在有心血管病史的患者中（23.6%），MACE 的发生率增加到 13.4%。在单变量分析中，年龄（比值比[OR] 1.062，P=0.04）、TnI（OR 1.12，P=0.0042）、HbA1c（OR 1.879，P=0.0076）和心血管病史（无 vs. 有 OR 0.027，P=0.0006）与 MACE 相关。TnI 在调整其他所有显著变量后仍然是独立的预测因子。当我们将分析仅限于有心血管病史的患者时，TnI 是唯一与 MACE 相关的统计学上显著变量。
移植前升高的 TnI 是移植后早期 MACE 的独立预测因子，特别是在有心血管病史的患者中。
