Pretransplant NT‐proBNP levels are associated with mortality among lung transplant recipients

Abstract

AbstractThe 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.