Abstract
Introduction: Cardiac troponin is utilized in decision making when considering a suitable donor for heart transplant (HT). To date, no pediatric study has assessed the impact of peak donor troponin or donor troponin trends on post-HT survival. Methods: All children in the Organ Procurement and Transplantation Network database undergoing HT in the U.S. from 2007 - 2020 and with donor troponin I levels recorded were included. Donors were divided into groups based on peak troponin value: Low (0-<25%ile), Medium (25-<75%ile), and High (>75%ile); and on differences between first and last troponin: Increasing : >20% increase, Persistently high : initial and final troponin high; Persistently low : initial and final troponin normal; Decreasing : >20% decrease. Donor characteristics were compared and effects of donor troponin on graft survival were evaluated both unadjusted and after multivariable adjustment using Cox proportional hazards model. Results: Of 5569 HT, troponin levels were available for 4572 (82%) recipients. Compared to donors with Low and Medium troponin values, donors with High troponin values were older (median age 3 vs. 7 vs. 13 years), male (59.2 vs. 59.5 vs. 64.7%), White (50.3 vs. 52.4 vs. 55.5%), died from anoxia (33.5 vs. 41.1 vs. 48.9%), with ejection fraction ≤55% (4.2 vs. 6.4 vs. 8.7%) and receive cardiopulmonary resuscitation [CPR] (44.3 vs. 53.7 vs. 63.3%) (p<.05 for all). Donors with Increasing and Persistently high troponin values were older, had lower ejection fraction and were more likely to receive CPR than those with Persistently low and Decreasing troponin (p<.05 for all). Neither unadjusted (Figures A, B) , nor multivariable adjusted outcomes revealed any differences in graft survival post-HT based on peak troponin or troponin trends (Figure C, Table A) Conclusions: Donor troponin values do not predict post-transplant survival in children undergoing HT. Our study will allow for safe expansion of donor heart utilization in pediatric HT.
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