Cardiac transplantation is an important treatment option for those patients with end stage heart failure who have failed to respond to disease modifying treatment. However, cardiac transplantation is not without risk, with the one year mortality around 19%,¹ and identifying patients at the highest risk of death is notoriously difficult.

Brain natriuretic peptide (BNP) and the N-terminal portion of pro-brain natriuretic peptide (NT-proBNP) are now well established diagnostic and adverse prognostic markers in all stages of congestive heart failure. Indeed, we have shown that NT-proBNP is predictive of death before cardiac transplantation.² Studies have also shown that increasing BNP concentrations precede cardiac allograft rejection and are associated with poor survival late after transplantation.³ However, the prognostic ability of NT-proBNP immediately after cardiac transplantation has not been evaluated. The goal of this study was therefore to assess the short term prognostic ability of NT-proBNP in patients after cardiac transplantation.

METHODS

We prospectively studied 26 consecutive patients undergoing orthotopic cardiac transplantation in the Scottish Cardiopulmonary Transplant Unit between September 2001 and September 2003. The primary end point was all cause mortality. The median follow up was 477 days (range 20–922 days). No patients were lost to follow up.

Blood for NT-proBNP was collected in EDTA containing tubes before each routine right ventricular endomyocardial biopsy. The samples were then spun at 3000 rpm for 10 minutes at 0°C. Plasma was extracted and frozen in aliquots at −70°C until analysis. NT-proBNP …