Liu Zhengyang, Perry Luke A, Penny-Dimri Jahan C, Handscombe Michael, Overmars Isabella, Plummer Mark, Segal Reny, Smith Julian A
Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia.
Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
Transplant Direct. 2021 Dec 13;8(1):e1261. doi: 10.1097/TXD.0000000000001261. eCollection 2022 Jan.
Cardiac troponin is a highly specific and widely available marker of myocardial injury, and elevations in cardiac transplant donors may influence donor selection. We aimed to investigate whether elevated donor troponin has a role as a prognostic biomarker in cardiac transplantation.
In a systematic review and meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library, without language restriction, from inception to December 2020. We included studies reporting the association of elevated donor troponin with recipient outcome after cardiac transplant. We generated summary odds ratios and hazard ratios for the association of elevated donor troponin with short- and long-term adverse outcomes. Methodological quality was monitored using the Quality In Prognosis Studies tool, and interstudy heterogeneity was assessed using a series of sensitivity and subgroup analyses.
We included 17 studies involving 15 443 patients undergoing cardiac transplantation. Elevated donor troponin was associated with increased odds of graft rejection at 1 y (odds ratio, 2.54; 95% confidence interval, 1.22-5.28). No significant prognostic relationship was found between donor troponin and primary graft failure, short- to long-term mortality, cardiac allograft vasculopathy, and pediatric graft loss.
Elevated donor troponin is not associated with an increased short- or long-term mortality postcardiac transplant despite increasing the risk of graft rejection at 1 y. Accordingly, an elevated donor troponin in isolation should not exclude donation.
心肌肌钙蛋白是心肌损伤的一种高度特异性且广泛应用的标志物，心脏移植供体中该指标升高可能会影响供体选择。我们旨在研究供体肌钙蛋白升高在心脏移植中是否可作为一种预后生物标志物。
在一项系统评价和荟萃分析中，我们检索了MEDLINE、Embase和Cochrane图书馆，检索时间从建库至2020年12月，无语言限制。我们纳入了报告供体肌钙蛋白升高与心脏移植后受者结局之间关联的研究。我们生成了供体肌钙蛋白升高与短期和长期不良结局关联的汇总比值比和风险比。使用预后研究质量工具监测方法学质量，并通过一系列敏感性和亚组分析评估研究间的异质性。
我们纳入了17项研究，涉及15443例接受心脏移植的患者。供体肌钙蛋白升高与1年时移植排斥反应几率增加相关（比值比，2.54；95%置信区间，1.22 - 5.28）。未发现供体肌钙蛋白与原发性移植失败、短期至长期死亡率、心脏移植血管病变和儿科移植失败之间存在显著的预后关系。
尽管供体肌钙蛋白升高会增加1年时移植排斥反应的风险，但与心脏移植后短期或长期死亡率增加无关。因此，孤立的供体肌钙蛋白升高不应排除捐赠。
