Plasma B-type natriuretic peptide levels in cardiac donors

Elevated levels of plasma brain natriuretic peptide (BNP) and amino-terminal BNP (NT-proBNP) are associated with adverse cardiac outcomes. It is not known whether BNP and NT-proBNP levels in heart donors can aid in selection and predict outcomes in transplant recipients.

Plasma BNP and NT-proBNP were measured in 32 organ donors prior to removal from life-support systems. Twelve hearts were accepted and 20 hearts were declined (no suitable recipient - 12, probable coronary artery disease - four, abnormal echocardiogram - three, other medical reasons - one). Records of heart transplant recipients were reviewed for: survival at 30 d, length of intensive care stay and need for intra-aortic balloon counter-pulsation (IABP).

Donors were divided into three groups - Group 1 (n = 12): accepted hearts; Group 2 (n = 12): acceptable hearts not transplanted for logistic reasons; Group 3 (n = 8): declined because of probable cardiac disease. BNP and NT-proBNP levels were significantly lower in donors with acceptable hearts (n = 24) compared with those with unacceptable hearts (n = 8) (p = 0.02 and 0.032, respectively). Of the 12 patients transplanted, four suffered a suboptimal outcome (two died, one required inotropic support and IABP, one prolonged hospitalization) while eight had good outcomes with no significant difference in BNP/NT-proBNP levels between these groups.

BNP and NT-proBNP levels were lower in organ donors whose hearts were acceptable for transplantation compared with those whose hearts were unsuitable. Measuring natriuretic peptides may be a useful adjunctive tool in the selection of donor hearts. We feel that further studies are warranted.