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  • Title: Sustained elevated concentrations of cardiac troponin T during acute allograft rejection after heart transplantation in children.
    Author: Wåhlander H, Kjellström C, Holmgren D.
    Journal: Transplantation; 2002 Oct 27; 74(8):1130-5. PubMed ID: 12438959.
    Abstract:
    BACKGROUND: The diagnosis of acute rejection after heart transplantation is made on the basis of endomyocardial biopsy. In children, where the method may be associated with complications, a noninvasive alternative would be desirable. We evaluated the myocardial damage marker cardiac troponin T (cTnT) as a marker of rejection in children who have undergone heart transplantation. METHODS: Peripheral venous blood was collected in 124 endomyocardial biopsies in 14 children who had undergone heart transplantation (1-20 years of age). Serum levels of cTnT were compared with histologic rejection according to the International Society of Heart and Lung Transplantation (ISHLT) (grades 0-4). RESULTS: Seven children experienced nine episodes of acute rejection. During rejection, cTnT increased from 0.05+/-0.07 (mean+/-SD) microg/L to 0.26+/-0.27 microg/L and remained elevated 7 and 30 days thereafter (0.10+/-0.11 and 0.36+/-0.38 microg/L, respectively) before returning to normal after 50 to 430 days. In surveillance biopsies, cTnT displayed considerable variation at all rejection grades: ISHLT grade 0, median 0.03 microg/L (range 0.01-2.04 microg/L); ISHLT grade 1, median 0.06 microg/L (range 0.01-0.67 microg/L); ISHLT grade 2, median 0.10 microg/L (range 0.01-1.42 microg/L); and ISHLT grade 3, median 0.17 microg/L (range 0.01-0.93 microg/L). A receiver operating characteristics analysis for cTnT versus rejection grade revealed an area under the curve of 0.69, indicating a moderate predictive value for cTnT. However, a cutoff of 0.015 microg/L yielded a specificity of only 36%, with a sensitivity of 89%, whereas a cutoff of 0.1 microg/L resulted in sensitivity and specificity of 53% and 77%, respectively. CONCLUSIONS: Cardiac troponin T increased and remained elevated for at least 1 month during acute rejection. The diagnostic power of a single cTnT measurement was not sufficient to replace endomyocardial biopsy.
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