*Purpose: Pretransplant cardiac troponin I (cTNI) has demonstrated its predictor value of survival after kidney transplant in previous studies. Growth differentiation factor 15 (GDF-15) is a biomarker currently studied as a predictor of mortality and cardiovascular events (CVE) in multiple scenarios. The aim of this study is to compare the utility of cTNI and GDF-15 to predict posttransplant mortality and CVE in a cohort of kidney transplant recipients.

*Methods: We included 359 kidney transplants performed between 2005 and 2015. cTNI and GDF-15 were measured on stored serum samples obtained pretransplant. Information about patients was extracted from the prospectively maintained database of renal transplant recipients at our center.

*Results: Receptors had a median age of 54.1 and were 67.4% male. 22% were diabetic before the transplant, whereas 9.5% and 8.1% had prior history of coronary and peripheral artery disease respectively. 16.5% transplants were performed preemptively. Median GDF-15 was 5346.4 (R=50.5-18607.3) pg/ml and median cTNI was 5.6 (R=2.5-691.4) ng/l. Patients were stratified in tertiles according to GDF-15 and cTNT levels. In the univariate analysis, higher levels of GDF-15 significantly related to overall mortality, stroke, acute coronary syndrome and major adverse cardiovascular events (MACE). Higher cTNI related to cardiovascular mortality, acute coronary syndrome and MACE, but not overall mortality (Log Rank p=0.4). By multivariate cox analysis, including both biomarkers and clinical characteristics (age, diabetes, prior coronary and peripheral artery disease and pretransplant renal replacement therapy), the relation between survival and GDF-15 remained significant for the highest tertile (HR 2.2 CI95% (1.2-4.1), p = 0.01). GDF-15 relation with cerebrovascular accidents and MACE remained significant after the adjustment by clinical characteristics [HR 9.7 CI95% (2.2-43.1), p = 0.003 and HR 2.7 CI95% (1.4-5.1), p = 0.002] for the highest risk tertile. On the contrary, posttransplant acute coronary syndrome was only related to cTNI tertiles and previous coronary artery disease in the multivariate model [HR 3.2 CI95% (1.5-7.3), p = 0.003 for the highest cTNI tertile].

*Conclusions: Our study highlights the potential utility of GDF-15 as a predictor of mortality and cardiovascular adverse events after transplant. By contrast, cardiac troponin was only related to acute coronary events, probably due to its specific production in myocardial tissue. Altogether, these two molecules could have high clinical potential in conjunction with clinical characteristics to better predict adverse events after kidney transplantation and find strategies to prevent them.

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