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Prognostic Value of B-Type Natriuretic Peptide in Liver Transplant Patients: Implication in Posttransplant Mortality

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Abstract
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 (postBNP(POD3)) were analyzed. Thirty-day all-cause mortality predicted by adding preBNP and/or postBNP(POD3) 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, postBNP(POD3) > 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 postBNP(POD3) > 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 postBNP(POD3) <= 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, postBNP(POD3), and both BNP to RCRI improved net reclassification index to 22.5%, 29.5%, and 33.1% of 30-day mortality, respectively.

Conclusions PostBNP(POD3) > 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.
Author(s)
권혜미김경선문영진송준걸신원정전인구허인영황규삼
Issued Date
2021
Type
Article
Keyword
liver transplantationB-type natriuretic peptidecirrhotic cardiomyopathy
DOI
10.1002/hep.31661
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8062
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2465753443&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Prognostic%20Value%20of%20B-Type%20Natriuretic%20Peptide%20in%20Liver%20Transplant%20Patients:%20Implication%20in%20Posttransplant%20Mortality&amp;offset=0&amp;pcAvailability=true
Publisher
HEPATOLOGY
Location
미국
Language
영어
ISSN
0270-9139
Citation Volume
74
Citation Number
1
Citation Start Page
336
Citation End Page
350
Appears in Collections:
Medicine > Medicine
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