Is B-type natriuretic peptide clinically useful after pediatric heart transplantation?

Abstract

The evidence for BNP-guided management of pediatric heart transplant recipients is scarce. A search in PubMed with no date or language restriction resulted in 8 studies reporting relation between BNP and rejection, 2 studies on the time course of BNP levels after heart transplantation, one study each reporting relationship of BNP with cardiac allograft vasculopathy and post-transplant mortality. So far, the data available can only support BNP as an adjunctive marker, not a stand-alone test, in the screening of hemodynamically significant cardiac pathology in pediatric heart transplant recipients. A serial intraindividual measurements of BNP level rather than an absolute cut-off value, can be useful in combination with the patient's clinical condition to facilitate management of post-heart transplant care in children.

Early findings after integration of donor‐derived cell‐free DNA into clinical care following pediatric heart transplantation

“…[6][7][8][9][10] These factors have prompted multiple attempts to identify less invasive alternatives to allograft surveillance for AR. [11][12][13][14][15][16][17] Most recently, the ability to quantify circulating, dd-cfDNA has shown promise toward fulfilling an important need for a validated, noninvasive biomarker for AR after HT. [18][19][20][21][22][23][24] While pediatric HT recipients were included in validation studies, 20,21 outcomes after integration of dd-cfDNA assessment into routine clinical practice after pediatric HT have not been described.…”

“…However, EMB is costly, invasive, and a source of distress for pediatric HT recipients 3–5 ; it is also of relatively low yield late after transplantation 6–10 . These factors have prompted multiple attempts to identify less invasive alternatives to allograft surveillance for AR 11–17 . Most recently, the ability to quantify circulating, dd‐cfDNA has shown promise toward fulfilling an important need for a validated, noninvasive biomarker for AR after HT 18–24 .…”