Key result
Elevated post-transplant day 3 BNP >2,000 pg/mL was associated with 22.4% 30-day mortality versus 0.9% for BNP ≤150 pg/mL, and adding peri-transplant BNP to the RCRI improved risk reclassification.
Why the study?
Despite frequent cirrhotic cardiomyopathy or subclinical heart failure, the prognostic value of peri-liver transplant BNP in advanced liver disease has been poorly studied.
Does peri-liver transplant BNP measurement improve risk stratification for 30-day mortality in liver transplant patients?
Cohort (n=3,811)
Does peri-liver transplant BNP measurement improve risk stratification for 30-day mortality in liver transplant patients?
Routine monitoring of peri-liver transplant BNP provides incremental prognostic information and improves risk stratification for 30-day mortality beyond the traditional Revised Cardiac Risk Index.
May aid post-liver transplant mortality stratification when added to RCRI; leaves open prospective validation before clinical adoption.
Background and Aims Despite frequent cirrhotic cardiomyopathy or subclinical heart failure (HF), the prognostic value of peri–liver transplant (LT) B‐type natriuretic peptide (BNP) has been poorly studied in advanced liver disease. We examined the association between BNP and mortality in a large cohort of LT patients and identified risk factors for peri‐LT BNP increase. Approach and Results Using prospectively collected data from the Asan LT Registry between 2008 and 2019, 3,811 patients who measured serial pretransplant BNP (preBNP) and peak BNP levels within the first 3 posttransplant days (postBNPPOD3) were analyzed. Thirty‐day all‐cause mortality predicted by adding preBNP and/or postBNPPOD3 to the traditional Revised Cardiac Risk Index (RCRI) was evaluated. PreBNP > 400 pg/mL (known cutoff of acute HF) was found in 298 (7.8%); however, postBNPPOD3 > 400 pg/mL was identified in 961 (25.2%) patients, specifically in 40.4% (531/1,315) of those with a Model for End‐Liver Disease score (MELDs) > 20. Strong predictors of postBNPPOD3 > 400 pg/mL were preBNP, hyponatremia, and MELDs, whereas those of preBNP > 400 pg/mL were MELDs, kidney failure, and respiratory failure. Among 100 (2.6%) post‐LT patients who died within 30 days, patients with postBNPPOD3 ≤ 150 pg/mL (43.1%, reference group), 150‐400 pg/mL (31.7%), 400‐1,000 pg/mL (18.5%), 1,000‐2,000 pg/mL (4.7%), and >2,000 pg/mL (2.0%) had 30‐day mortalities of 0.9%, 2.2%, 4.0%, 7.7%, and 22.4%, respectively. Adding preBNP, postBNPPOD3, and both BNP to RCRI improved net reclassification index to 22.5%, 29.5%, and 33.1% of 30‐day mortality, respectively. Conclusions PostBNPPOD3 > 400 pg/mL after LT was markedly prevalent in advanced liver disease and mainly linked to elevated preBNP. Routine monitoring of peri‐LT BNP provides incremental prognostic information; therefore, it could help risk stratification for mortality as a practical and useful biomarker in LT.
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Kwon et al. (2020) conducted a cohort in Advanced liver disease undergoing liver transplant (n=3,811). Elevated peri-liver transplant BNP vs. Low peri-liver transplant BNP (≤ 150 pg/mL) was evaluated on 30-day all-cause mortality. Elevated post-transplant day 3 BNP >2,000 pg/mL was associated with 22.4% 30-day mortality versus 0.9% for BNP ≤150 pg/mL, and adding peri-transplant BNP to the RCRI improved risk reclassification.
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