Pretransplant NT-proBNP levels are associated with mortality among lung transplant recipients
Shimon Izhakian, Assaf Frajman, Ariel D. Hayat, Alon Gorenshtein, Osnat Shtraichman, Lev Freidkin, Dror Rosengarten, Mordechai R. Kramer
https://doi.org/10.1002/pul2.12427
Abstract
The prognostic significance of pretransplant N-terminal pro-brain (B)-type natriuretic peptide (NT-proBNP) level has not been investigated in lung transplant recipients. The electronic files of 173 patients with chronic lung disease who underwent lung transplantation in 2018–2022 at a tertiary medical center were retrospectively reviewed. Right heart catheterization (RHC) and NT-proBNP determination were performed preoperatively in all cases. Pretransplant demographic, clinical, and laboratory data were compared between posttransplant survivors and nonsurvivors. Correlations of NT-proBNP values with lung function and RHC parameters and all-cause mortality were analyzed. NT-proBNP level correlated positively with mean pulmonary artery pressure (R = 0.51, p < 0.001) and pulmonary vascular resistance (PVR) (R = 0.45, p = 0.0013), and negatively with diffusing lung capacity for carbon monoxide (R = −0.25, p = 0.0017), cardiac index (R = −0.26, p = 0.001), and cardiac output (R = −0.23, p = 0.004). Over a median follow-up time of 23.22 months, 74 patients died. On univariate analysis, mortality was significantly associated with higher log-NT-proBNP (hazard ratio [HR] = 0.54, 95% confidence interval [CI] 1.15–2.05, p = 0.016), older age at transplant registration (HR = 1.033, 95% CI 1.009–1.058, p = 0.0068), higher PVR (HR 1.15, 95% CI 1.07–1.23, p = 0.015), and lower cardiac output (HR = 0.62, 95% CI 0.42–0.92, p = 0.045). On multivariate analysis adjusted for age, sex, and body mass index, mortality significance was maintained only for higher log-NT-proBNP (HR = 1.54, 95% CI 1.12–2.11, p = 0.007). Among lung transplant recipients, pretransplant NT-proBNP levels correlated well with RHC parameters and were strongly associated with posttransplantation mortality. Assessment of NT-proBNP may improve risk stratification of lung transplant candidates.