Related Experiment Video
Updated: Apr 4, 2026
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Elevated Cardiac Troponin I in Preservation Solution Is Associated With Primary Graft Dysfunction
Matthew A Schechter1, Michael J Watson1, Bryan J Feger1
1Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Insights
Primary graft dysfunction (PGD) after heart transplant is linked to higher cardiac troponin I (cTnI) levels in preservation solution. This suggests preservation injury may drive PGD development.
Area of Science:
- Cardiology
- Transplantation Medicine
- Biomarker Research
Background:
- Primary graft dysfunction (PGD) is a major cause of early mortality and morbidity after heart transplantation.
- Mechanisms underlying PGD development remain incompletely understood.
Purpose of the Study:
- To investigate the association between cardiac troponin I (cTnI) concentrations in preservation solutions and the incidence of PGD.
- To explore potential mechanisms of PGD, specifically focusing on preservation injury.
Main Methods:
- Analysis of preservation solutions from 43 heart transplant procedures using the i-STAT System.
- Measurement of normalized cardiac troponin I (cTnI) levels, adjusted for left ventricular mass.
- Review of recipient medical records to diagnose PGD based on 2014 ISHLT criteria.
Main Results:
- Nineteen patients developed PGD post-transplantation.
- Significantly elevated normalized cTnI levels were observed in preservation solutions of patients who developed PGD compared to those who did not (P = .031 for UW, P = .034 for Custodiol).
- cTnI levels correlated with ischemic time in the University of Wisconsin (UW) solution group, but not in the Custodiol group.
Conclusions:
- Elevated cTnI in preservation solution is significantly associated with PGD development.
- These findings suggest that preservation-induced injury may be a key mechanism contributing to PGD after heart transplantation.
Background:
Although primary graft dysfunction (PGD) is a leading cause of mortality and morbidity early post-heart transplant, relatively little is known regarding mechanisms involved in PGD development.
Methods And Results:
We examined the relationship between cardiac troponin I (cTnI) concentrations in the preservation solution from 43 heart transplant procedures and the development of PGD. Donor hearts were flushed with cold preservation solution (University of Wisconsin [UW] or Custodiol) and stored in the same solution. cTnI concentrations were measured utilizing the i-STAT System and normalized to left ventricular mass. Recipient medical records were reviewed to determine PGD according to the 2014 ISHLT consensus conference. Nineteen patients developed PGD following cardiac transplantation. For both UW and Custodiol, normalized cTnI levels were significantly increased (P = .031 and .034, respectively) for those cases that developed PGD versus no PGD. cTnI levels correlated with duration of ischemic time in the UW group, but not for the Custodiol group. Donor age and donor cTnI (obtained prior to organ procurement) did not correlate with preservation cTnI levels in either UW or Custodiol.
Conclusions:
Increased preservation solution cTnI is associated with the development of PGD suggesting preservation injury may be a dominant mechanism for the development of PGD.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies