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

OBJECTIVE
The post-operative serum level of N-terminal pro-brain natriuretic peptide (NT-proBNP) has been found to be associated with post-operative cardiovascular complications and mortality in high-risk surgeries. The usefulness of 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 liver transplantation (LDLT) with data of post-operative NT-proBNP level values were retrospectively analyzed for in-hospital mortality. The highest post-operative NT-proBNP level from the first 3 days after surgery was included in the study. Receiver operating characteristic curve analysis was performed to assess the best cut-off value of post-operative NT-proBNP, and Cox regression analysis was performed to investigate the effect of NT-proBNP on mortality.

RESULTS
A total of 114 LT recipients with a mean Model for End-Stage Liver Disease score of 15.8 were included in the study. In-hospital mortality occurred in 11 (9.6%) of the patients. A history of diabetes mellitus and the post-operative NT-proBNP level were found to be associated with mortality (p=0.011 for diabetes mellitus and p<0.001 for NT-proBNP). The best cut-off value of post-operative NT-proBNP was 1009 ng/L. Cox regression analysis indicated that 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 who underwent LDLT. Post-operative NT-proBNP-guided management of LT recipients should be pursued.