Key result
A transient decrease in B-type natriuretic peptide levels after liver transplantation (deltaBNP < 0) was associated with a higher 30-day mortality rate (6.1% vs 2.0%) and an increased risk of death (adjusted HR 1.64) compared to an increase in BNP.
Why the study?
Although high BNP levels within the first 3 postoperative days after liver transplantation predict 30-day mortality, the clinical impact of a transient decrease in BNP compared to pretransplant levels remained unknown.
Does a transient decrease in BNP level after liver transplantation predict favorable 30-day mortality and cardiovascular outcomes?
Cohort (n=3,811)
No
Does a transient decrease in BNP level after liver transplantation predict favorable 30-day mortality and cardiovascular outcomes?
A transient decrease in BNP levels within the first 3 days after liver transplantation is paradoxically associated with higher 30-day mortality and MACE, likely reflecting more severe pre-transplant liver and cardiac disease rather than improved cardiac status.
Transient BNP decrease after LT was associated with lower 30-day mortality and MACE; leaves open whether deltaBNP monitoring refines risk stratification.
BACKGROUND: High B-type natriuretic peptide (BNP) levels within the first 3 postoperative days (postBNPPOD3) after liver transplantation (LT) are greatly predictive of the 30-day mortality. We evaluated clinical impact of transient decrease in postBNPPOD3 compared to pretransplant BNP (preBNP) level on mortality and major adverse cardiac event (MACE) within 30 days after LT. METHODS: We retrospectively evaluated 3,811 LT patients who measured delta BNP (deltaBNP), defined by serial postBNPPOD3 minus preBNP. Thirty-day all-cause mortality and MACE were estimated in patients with deltaBNP < 0 (n = 594, 15.6%) and > 0 (n = 3,217, 84.4%), respectively. Kaplan-Meier survival and multivariable Cox regression analysis were used. RESULTS: Within 30 days, 100 (2.6%) of all patients died. Unexpectedly, 30-day mortality rate (6.1% [95% CI: 4.2-8.4%] vs. 2.0% [95% CI: 1.5-2.5%], P < 0.001) and MACE (24.2% [95% CI: 20.4-28.5%] vs. 15.3% [95% CI: 14.0-16.7%], P < 0.001) were higher in patients with deltaBNP < 0 compared to those with deltaBNP > 0, respectively. Patients with deltaBNP < 0 had higher preBNP level (median [interquartile range], 251 [118, 586] vs. 43 [21, 92] pg/ml, P < 0.001) and model for end-stage liver disease score (26 [14, 37] vs. 14 [9, 23], P < 0.001) and more transfused intraoperatively. DeltaBNP < 0 remained significant after adjustments for potential confounders in multivariable analysis of 30-day mortality and MACE. CONCLUSIONS: DeltaBNP < 0 within the first 3 postoperative days is mainly attributed to pre-LT severe liver and cardiac disease status, therefore, transient decrease in BNP level after LT does not ensure favorable post-LT 30-day outcomes.
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Kwon et al. (2023) conducted a cohort in End-stage liver disease (n=3,811). Transient decrease in B-type natriuretic peptide (deltaBNP < 0) vs. Increase in B-type natriuretic peptide (deltaBNP > 0) was evaluated on 30-day all-cause mortality (HR 1.64, 95% CI 1.07-2.51, p=0.023). A transient decrease in B-type natriuretic peptide levels after liver transplantation (deltaBNP < 0) was associated with a higher 30-day mortality rate (6.1% vs 2.0%) and an increased risk of death (adjusted HR 1.64) compared to an increase in BNP.
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