Post-operative N-terminal pro-brain natriuretic peptide predicts in-hospital mortality after living donor liver transplantation

Abstract

Objective: The post-operative serum level of N-terminalpro-brain natriuretic peptide (NT-proBNP) has been foundto be associated with post-operative cardiovascular complications and mortality in high-risk surgeries. The usefulnessof the post-operative NT-proBNP level as a predictor of mortality after liver transplantation (LT) is unknown.Methods: The records of patients at a single, tertiary university hospital who had undergone adult living donor livertransplantation (LDLT) with data of post-operative NTproBNP level values were retrospectively analyzed for in--hospital mortality. The highest post-operative NT-proBNPlevel from the first 3 days after surgery was included in thestudy. Receiver operating characteristic curve analysis wasperformed to assess the best cut-off value of post-operativeNT-proBNP, and Cox regression analysis was performed toinvestigate the effect of NT-proBNP on mortality.Results: A total of 114 LT recipients with a mean Modelfor End-Stage Liver Disease score of 15.8 were includedin the study. In-hospital mortality occurred in 11 (9.6%) ofthe patients. A history of diabetes mellitus and the post-operative NT-proBNP level were found to be associated withmortality (p=0.011 for diabetes mellitus and p<0.001 forNT-proBNP). The best cut-off value of post-operative NTproBNP was 1009 ng/L. Cox regression analysis indicatedthat the NT-proBNP level was a strong predictor of in-hospital mortality (hazard ratio: 24.467, 95% confidence interval:3.120–191.750; p=0.002).Conclusion: The post-operative NT-proBNP serum level independently predicted in-hospital mortality in patients whounderwent LDLT. Post-operative NT-proBNP-guided management of LT recipients should be pursued.