The Change in B-Type Natriuretic Peptide Levels Over Time Predicts Significant Rejection in Cardiac Transplant Recipients

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.…”

“…18 Studies on prognostic value have generally applied regression models, using the difference between two biomarker measurements as the determinant. 7,8 Although these methods disregard the full temporal evolution of the biomarkers, JM takes into account the total number of repeated measurements available. 11 Because biomarker levels may change at a certain moment in time when a (subclinical) pathologic state sets in, this approach results in less bias compared to simplified models.…”

Correlation of noninvasive markers of cardiac allograft rejection with endomyocardial biopsy: A case report

“…Although the patient appeared clinically well, he had increasing levels of B-type natriuretic peptide (BNP) from 286 pg/ mL in the immediate postoperative period to 693 pg/mL on PTD 13, indicative of acute rejection. 1,2 The clinical examination at the time revealed absent jugular venous distention and normal cardiac examination with no audible S3. There was no pedal edema, and distal perfusion was normal.…”

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].…”

“…Kittleson et al [94] assessed 146 transplant recipients with 763 biopsy specimens and reported a strong, graded relationship between the within-individual increase in NT-proBNP and the odds of significant (>2R) rejection, both in the first year and subsequent years after transplantation. A twofold increase in NTproBNP was associated with a positive predictive value (PPV) of 22%, a fivefold increase associated with a PPV of 31% and a tenfold increase with a PPV of 57%.…”