Introduction: Soluble ST2(sST2), involved in T-cell mediated inflammation and cardiac fibrosis, is a better predictor of cardiovascular events(CVE) in heart failure(HF) and is less affected by GFR than cardiac troponin T(cTnT). We assessed variables associated with sST2 and whether it predicts outcomes in kidney transplant(KTx) candidates. Methods: We measured sST2 and cTnT in 200 consecutives KTx candidates. Elevated sST2 defined as ≥30ng/ml and cTnT as ≥0.01ng/ml. Adverse outcome was defined as CVE(cardiac or peripheral vascular disease requiring intervention, HF, or stroke) or death following KTx evaluation. Results: Mean age 51±13years, 60% male, 39% diabetic(DM), 60% on dialysis, 34% had history of CVE and 16% positive stress echocardiogram. sST2 and cTnT were elevated in 85(43%) and 113(57%) candidates, respectively. After mean follow-up of 19±11months, 42% were transplanted, 26(13%) had CVE and 15(8%) died. sST2 was associated with male gender (OR 3.27,p<0.001), cTnT (OR 3.13,p<0.001), history of CVE (OR 2.66,p=0.001), positive stress test (OR 2.53,p=0.04), left ventricular hypertrophy (LVH) (OR 2.32,p=0.01), prior transplant (OR 2.31,p=0.02) and transplant-free status (patients without transplant at follow-up) (OR 2.31,p=0.01). On multivariate analysis, only male gender, transplant-free status and LVH were independently associated with elevated sST2. On multivariate analysis, elevated cTnT was not associated with prior transplant or transplant-free status but with male gender, DM and dialysis status. On univariate analysis, sST2 and cTnT were both significantly associated with adverse outcome. On multivariate cox analysis, older age, DM and cTnT were independent predictors of adverse outcome.

Discussion. sST2 is significantly correlated with cTnT and may provide additional prognostication in KTx candidates. Predictors of sST2 differ from cTnT suggesting that these biomarkers represent different pathophysiologic mechanisms associated with CVE. Larger studies are needed to evaluate whether sST2 improves CVE risk prediction in KTx candidates.

CITATION INFORMATION: Keddis M, El-Zoghby Z, Gray A, Meeusen J, Donato L, Cosio F, Steidley D. Soluble ST2 and Cardiovascular (CV) Outcomes and Mortality in Kidney Transplant Candidates. Am J Transplant. 2016;16 (suppl 3).

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