Changes in serial B-type natriuretic peptide level independently predict cardiac allograft rejection

Repeated Measurements of NT-pro-B-Type Natriuretic Peptide, Troponin T or C-Reactive Protein Do Not Predict Future Allograft Rejection in Heart Transplant Recipients

“…Few studies have examined prognostic value of repeated measurements of NT-proBNP or BNP for AR. Arora et al 9 examined changes in NT-proBNP and did not find any association with acute cellular rejection, whereas Garrido et al, 8 Kittleson et al, 7 Martinez-Dolz et al, 28 and Damodaran et al 29 found positive associations between changes in BNP and NT-proBNP and AR. None of these prognostic studies have used all the available biomarker measurements in their analyses.…”

What Role Should B-Type Natriuretic Peptide Play in Predicting Late Graft Dysfunction Following Cardiac Transplantation?

“…There have been limited reports indicating that BNP levels tend to be higher around the time of late graft dysfunction (LGD) following cardiac transplantation. [1][2][3] Objective: To assess the utility of serial BNP testing as a predictive indicator for LGD. Methods: We retrospectively reviewed heart transplantations performed at our center between 2012 and 2015, and compared the time course of BNP levels in the group of patients with LGD (defined as ejection fraction ≤50% and/or cardiac index <2) to that in the group without LGD.…”

Biomarkers of Acute Rejection Following Cardiac Transplantation

“…Very high concentrations of BNP/NT-proBNP have been observed in the early period following CTx, decreasing thereafter and reaching a plateau by about 6-months post-transplantation [82][83][84][85][86]. While acute rejection has been associated with elevated concentrations of circulating BNP [87][88][89][90] and NT-proBNP [85,91], more recent evidence would suggest that serial changes in BNP and NT-proBNP are better predictors of acute rejection than absolute values [85,[91][92][93][94].…”

“…Damodaran et al [92] examined circulating concentrations of BNP in 205 patients undergoing a total of 4007 biospies. There were 47 episodes of grade 3A (2R) rejection and a change in BNP by more than 100 pg/ml demonstrated a high PPV (93.3%) for the diagnosis of grade 3A rejection with an excellent negative predictive value (97.3%).…”

“…The largest of these studies was conducted by Damodaran et al [92] and involved more than 4000 samples. However, they did not include patients within the first 6 months following transplantation, when the risk of rejection is greatest and circulating concentrations of BNP/NT-proBNP are more likely to be elevated for reasons other than rejection, such as renal dysfunction.…”