Madan Shivank, Saeed Omar, Shin Jooyoung, Sims Daniel, Goldstein Daniel, Piña Ileana, Jorde Ulrich, Patel Snehal R
From the Division of Cardiology, Department of Medicine (S.M., O.S., J.S., D.S., I.P., U.J., S.R.P.) and Department of Cardiovascular and Thoracic Surgery (D.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Circ Heart Fail. 2016 Jun;9(6). doi: 10.1161/CIRCHEARTFAILURE.115.002909.
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.
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.
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.
尽管器官供应有限，但在潜在的供体心脏中，只有三分之一被接受用于移植。供体肌钙蛋白水平升高通常被视为心脏移植的禁忌症；然而，支持这种做法的数据有限。
我们在器官共享联合网络（UNOS）数据库中识别出10943名成年（≥18岁）心脏移植受者，这些受者的供体左心室射血分数保持正常（≥50%）且有供体肌钙蛋白I峰值数据。当作为连续变量进行分析时，在未调整的（风险比，0.999；95%置信区间，0.997 - 1.002；P = 0.856）和调整后的Cox模型中（风险比，1.000；95%置信区间，0.997 - 1.002；P = 0.950），供体肌钙蛋白峰值水平与随访1年时受者死亡率之间均无关联。接下来，我们根据供体肌钙蛋白I值将整个队列分为三组：<1 ng/mL（n = 7812）、1至10 ng/mL（n = 2770）和>10 ng/mL（n = 361）。使用未调整和调整后的Cox模型以及Kaplan - Meier分析，三组之间在30天、1年、3年或5年时受者死亡率无显著差异。同样，三组供体肌钙蛋白组在随访5年时的心脏移植血管病变以及移植后30天内的原发性移植失败情况也无差异。各组移植后的中位住院时间也相似。
在左心室射血分数保持正常的情况下，供体肌钙蛋白I水平升高与接受移植心脏的中期死亡率、心脏移植血管病变或原发性移植失败率无关。这一发现有助于扩大供体库。
