Elevated Cardiac Troponin I in Preservation Solution Is Associated With Primary Graft Dysfunction

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.