Troponin i levels and postoperative myocardial infarction following renal transplantation

G. R. Shroff, S. K. Akkina, M. D. Miedema, R. Madlon-Kay, C. A. Herzog, B. L. Kasiske

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10 Scopus citations

Abstract

Background: The relationship of routine postoperative troponin I (TnI) monitoring in kidney transplant recipients and in-hospital myocardial infarction (MI) is not known. Methods: This observational study evaluated the prevalence of abnormal postoperative TnI (Ortho Clinical Diagnostics assay) in 376 consecutive kidney or kidney/pancreas transplant recipients. In-hospital MI was adjudicated using the universal definition. Rates of death and coronary revascularizations at 1 year were studied. Logistic regression analysis was performed to identify independent predictors of abnormal TnI. Results: Ninety-five (25%) recipients had abnormal TnI (>0.04 ng/ml) following transplantation. Abnormal TnI levels were more common in older (mean age: 52.2 ± 13.4 vs. 48.3 ± 13.2 years, p = 0.01), diabetic (57.9 vs. 45.6%, p = 0.04), and prior coronary artery disease (31.6 vs. 20.3%, p = 0.02) patients. In-hospital MI occurred in 6 patients (1.6%). All subsequent in-hospital cardiovascular events occurred in the abnormal postoperative TnI group; most in those with TnI levels >1 ng/ml. Previous coronary artery disease was the only independent predictor of a postoperative TnI level >1 ng/ml in multivariate analysis (odds ratio 4.61, 95% confidence interval 1.49-14.32). At 1 year there was no significant difference in death (3.2 vs. 1.8%, p = 0.42) and borderline significant difference in coronary revascularization (5.3 vs. 1.4%, p = 0.049) in abnormal versus normal TnI groups. Conclusions: In-hospital MI was infrequent, but abnormal TnI highly prevalent following renal transplantation. Normal TnI levels following renal transplantation had a high negative predictive value in excluding patients likely to develop subsequent postoperative MI. The role of a higher TnI cut-off for screening for postoperative MI in high-risk subgroups deserves future prospective evaluation.

Original languageEnglish (US)
Pages (from-to)175-180
Number of pages6
JournalAmerican Journal of Nephrology
Volume35
Issue number2
DOIs
StatePublished - Feb 2012

Keywords

  • Myocardial infarction
  • Postoperative
  • Transplant
  • Troponin

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    Shroff, G. R., Akkina, S. K., Miedema, M. D., Madlon-Kay, R., Herzog, C. A., & Kasiske, B. L. (2012). Troponin i levels and postoperative myocardial infarction following renal transplantation. American Journal of Nephrology, 35(2), 175-180. https://doi.org/10.1159/000335679