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Transient decrease in B-type natriuretic peptide level after liver transplantation does not ensure favorable

Hye-Mee Kwon1, Jae Hwan Kim1, Sa-Jin Kang1

  • 1Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Anesthesia and Pain Medicine
|May 14, 2023
PubMed
Summary

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A transient decrease in B-type natriuretic peptide (BNP) after liver transplantation (LT) is linked to higher mortality. This finding suggests that a drop in BNP does not guarantee better outcomes post-LT.

Area of Science:

  • Cardiology
  • Hepatology
  • Transplantation Medicine

Background:

  • Elevated B-type natriuretic peptide (BNP) post-liver transplantation (LT) predicts 30-day mortality.
  • The clinical significance of a transient decrease in postoperative BNP levels compared to pre-transplant levels requires evaluation.

Purpose of the Study:

  • To assess the impact of a transient decrease in postoperative BNP (postBNPPOD3) compared to pre-transplant BNP (preBNP) on 30-day mortality and major adverse cardiac events (MACE) after LT.

Main Methods:

  • Retrospective analysis of 3,811 LT patients measuring delta BNP (deltaBNP = postBNPPOD3 - preBNP).
  • Comparison of 30-day mortality and MACE rates between patients with deltaBNP < 0 and deltaBNP > 0.
  • Kaplan-Meier survival and multivariable Cox regression analyses were employed.
Keywords:
Liver transplantationMajor averse cardiovascular eventMortalityNatriuretic peptide, brain

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Main Results:

  • Patients with deltaBNP < 0 exhibited significantly higher 30-day mortality (6.1% vs. 2.0%) and MACE (24.2% vs. 15.3%) compared to those with deltaBNP > 0.
  • The deltaBNP < 0 group had higher preBNP levels, elevated Model for End-Stage Liver Disease (MELD) scores, and received more intraoperative transfusions.
  • DeltaBNP < 0 remained an independent predictor of 30-day mortality and MACE after multivariable adjustment.

Conclusions:

  • A transient decrease in BNP post-LT (deltaBNP < 0) is primarily associated with severe pre-existing liver and cardiac conditions.
  • This BNP decrease does not indicate favorable 30-day outcomes and is linked to increased mortality and MACE.