Ž . Clinica Chimica Acta 312 2001 31–39 www.elsevier.comrlocaterclinchim Cardiac troponin T and C-reactive protein as markers of acute cardiac allograft rejection Jeffrey J. Chance a , Jodi B. Segal b , Gail Wallerson a , Edward Kasper b , Ralph H. Hruban a , Thomas S. Kickler a , Daniel W. Chan a, ) a Department of Pathology, Johns Hopkins Hospital, 600 N. Wolfe Street r Meyer B-125, Baltimore, MD 21287-7065, USA b Department of Medicine, Johns Hopkins UniÕersity School of Medicine, Baltimore, MD 21287-7065, USA Received 2 August 2000; received in revised form 14 May 2001; accepted 21 May 2001 Abstract Due to myocyte damage and an associated inflammatory response, it is possible that cardiac troponin T and C-reactive Ž . protein CRP concentrations may correlate with the histologic grade of rejection in endomyocardial biopsy samples obtained from patients who have received a heart transplant. In this study, 704 blood samples were obtained from 145 different heart transplant recipients just prior to endomyocardial biopsy. Plasma specimens were assayed for troponin T and CRP concentration and the results compared with the assigned International Society of Heart and Lung Transplantation Ž . ISHLT histologic grade. Rejection was defined as an ISHLT grade of 3A or higher. The negative predictive values were near 80% in all cases, and a statistically significant increase in median troponin T concentration was observed across ISHLT Ž . grades. After the first month posttransplantation, the specificity of the troponin T test cutoff 0.1 ngrml was 95% and increased to 98% when false positives seen in renal disease patients were excluded. Both tests demonstrated poor sensitivity and positive predictive value for rejection. Neither CRP nor troponin T had sufficient sensitivity to serve as an alternative to endomyocardial biopsy in the diagnosis of acute cardiac allograft rejection. However, the troponin T test had a high specificity, especially when patients with renal insufficiency were excluded, and could serve as an adjunct test in this setting. When combined with a normal serum creatinine, a troponin T G0.1 ngrml prior to endomyocardial biopsy correlated with graft rejection in almost all cases, making biopsy unnecessary. q 2001 Elsevier Science B.V. All rights reserved. Keywords: Troponin T; C-reactive protein; Cardiac markers; Heart transplantation; Biopsy 1. Introduction There were 2184 heart transplants performed in wx the United States in 1999 and 2340 in 1998 1 . The ) Corresponding author. Tel.: q 1-410-955-2674; fax: q 1-410- 955-0767. Ž . E-mail address: dchan@jhmi.edu D.W. Chan . 1-year survival rate is 85.7%, while the 3- and 5-year survival rates are 76.7 and 69.5%, respectively. Given the importance of early diagnosis of acute cellular rejection to ensure allograft survival, the endomyo- cardial biopsy has become the Agold standardB for w x assessing rejection 2,3 . However, the endomyo- cardial biopsy is an expensive, invasive, time-con- suming and uncomfortable procedure with definite 0009-8981r01r$ - see front matter q 2001 Elsevier Science B.V. All rights reserved. Ž . PII: S0009-8981 01 00590-3