Date: Sunday, June 12, 2016
Session Time: 2:30pm-4:00pm
Presentation Time: 2:42pm-2:54pm
Location: Room 304
Introduction. Elevated levels of the biomarker cardiac troponin T levels (cTNT) pre- KTX relates to high mortality and CV risk pre and post-KTX. We sought to determine whether abnormal cTNT levels measured routinely post-KTX in asymptomatic recipients might uncover unrecognized cardiac pathology that might be associated with high mortality.
Methods. Included are 1114 recipients with cTNT measured pre and at regular intervals post-KTX and followed for 49.6+28.9 months (59% males, 43% pre-emptive and 84% living donors). Pre-KTX, 24% had diabetes and 29% had history of CV disease. Post-KTX there were 6079 cTNT measurements (median 5 (1-36)/recipient). cTNT<0.01 ng/ml was considered normal.
Results. Post-KTX 64 recipients (5.7%) had clinical non-fatal cardiac events (MACE) and 172 had asymptomatic elevations in cTNT. Compared to recipients without MACE or cTNT elevations, mortality was higher after non-fatal MACE [HR=3.10 (1.65-5.85) p<0.0001] and after cTNT elevations [HR=3.50 (2.33-5.26), p<0.0001]. Risk associated with cTNT elevations increased with increasing cTNT levels (0.01-0.03 ng/ml, HR=3.32; >0.1, HR=6.98). One time elevations in cTNT related to increased risk but the risk was higher when cTNT was elevated more than once. Risk factors for MACE and cTNT elevations were similar (age, males, diabetes, lower GFR). The cumulative incidence of MACE/cTNT also related to cTNT levels pre-KTX (Table) and time on dialysis. 115 recipients expired (10.3%). By multivariate analysis, mortality related to MACE/cTNT elevations (HR=5.11 (3.29-7.93), p<0.0001], older recipient age [HR=1.51 (1.43-1.59), p<0.0001], diabetes [HR=1.57 (1.01-2.44), p=0.044] and lower graft function [HR=1.17 (1.13-1.22), p=0.004]. Risk of CV death increased 65.8 fold after non-fatal MACE/cTNT elevations.
Discussion. After KTX cardiac pathologies are often not clinically overt but can be detected by elevated cTNT levels. Risk of death is similarly increased after clinical or not clinical cardiac events. High cTNT levels pre-KTX and exposure to dialysis relate to persistent risk of cardiac events post-KTX. cTNT elevations in KTX, even when asymptomatic, are not spurious but indicative of a high risk recipient in whom full cardioprotective measures should be applied.
|cTNT pre-KTX||3y||5 y||10 y|
CITATION INFORMATION: Cosio F, Amer H, Keddis M, Jaffe A. Clinical and Subclinical Cardiac Events After Kidney Transplantation (KTX). Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Cosio F, Amer H, Keddis M, Jaffe A. Clinical and Subclinical Cardiac Events After Kidney Transplantation (KTX). [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-and-subclinical-cardiac-events-after-kidney-transplantation-ktx/. Accessed February 23, 2019.
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