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Association Between High Sensitivity Troponin Levels Following Pediatric Orthotopic Heart Transplantation and Intensive Care Unit Resource Utilization

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Abstract

The utility of troponin levels, including high sensitivity troponin T (hs-TnT), after orthotopic heart transplant (OHT) is controversial. Conflicting data exist regarding its use as a marker of acute rejection. Few studies have examined possible associations of hs-TnT levels immediately after OHT with metrics of intensive care unit (ICU) resource utilization or risk of acute rejection. We performed a retrospective cohort chart review including all OHT recipients < 20 years of age at our center between June 2019 and December 2022. Patients were divided into two groups based on supra- or sub-median initial hs-TnT levels (median 3462.5 ng/L). Primary outcome was days requiring ICU-level care, secondary outcomes included days intubated, days requiring positive pressure ventilation (PPV), days on inotropic medications, actual ICU length of stay, Vasoactive Inotrope Scores (VIS) on postoperative days (POD) 0 through 7, and acute rejection at 30 days and one year after OHT. Patients with higher hs-TnT required ICU level care for longer [13.5 (10–17.5) vs. 9.5 (8–12) days, p = 0.01] and spent more days intubated [6 (4–7) vs. 3 (3–5) days, p < 0.001], on PPV [9 (6–15) vs. 6 (5–8.5) days, p = 0.02], and on inotropes [11 (9–14) vs. 8 (7–11) days, p = 0.025]. VIS was only different between groups on POD7 [5 (3–7) vs. 3 (0–5), p = 0.04]. There was no difference in rejection between the groups. Higher hs-TnT immediately following pediatric OHT may predict higher ICU resource utilization, despite no difference in VIS, although it does not predict acute rejection in the first year after OHT.

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Acknowledgements

We thank perfusionist Michael Brewer for his help obtaining data informing cardiopulmonary bypass and aortic cross-clamp times, Dr. Tania Gennell for her help obtaining exact times for ECMO cannulation and flow for relevant patients, and Dr. Arthur Smerling for his insight.

Funding

Funding for this project was received through grants from Colin’s Kids Foundation and Matthew’s Hearts of Hope, Inc.

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA

    Adam M. Butensky, Shyam Desai, Michael Dilorenzo, Irene D. Lytrivi, Yun Zhang & Tarif A. Choudhury

  2. Division of Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Benjamin S. Mantell

  3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Benjamin S. Mantell

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  1. Adam M. Butensky
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Contributions

A.B. Performed data analysis, wrote the main manuscript text, and prepared all figures and tables. S.D. Performed patient chart review and data entry. M.D., I.L., B.M., and T.C. assisted with research methodology. I.L. and B.M. provided insight as transplant specialists. Y.Z. assisted with data analysis, statistics consultation, and table preparation. All authors reviewed the manuscript.

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Correspondence to Adam M. Butensky.

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Butensky, A.M., Desai, S., Dilorenzo, M. et al. Association Between High Sensitivity Troponin Levels Following Pediatric Orthotopic Heart Transplantation and Intensive Care Unit Resource Utilization. Pediatr Cardiol 45, 829–839 (2024). https://doi.org/10.1007/s00246-024-03424-w

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