Daljeet Chahal1, Alan Yau2, Paola Casciato3, Vladimir Marquez2. 1. Postgraduate Medicine Program, University of British Columbia, Vancouver, British Columbia. 2. Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia. 3. Hospital Italiano, Buenos Aires, Argentina.
Abstract
Background: Cirrhotic patients undergoing liver transplantation are at risk of cardiac complications. Brain natriuretic peptide (BNP) and amino terminal brain natriuretic peptide (NT-BNP) are used in cardiac risk stratification. Their significance in predicting mortality risk in cirrhotic patients during or after liver transplantation is unknown. We conducted a systematic review and meta-analysis to answer this question. Methods: An electronic search of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (2005-September 2016), Google Scholar, and study bibliographies was conducted. Study quality was determined, and demographic and outcome data were gathered. Random effects meta-analyses of mortality-based BNP and NT-BNP level or presence of post-transplant heart failure were conducted. Results: Seven studies including 2,010 patients were identified. Demographics were similar between patients with high or low BNP or NT-BNP levels. Hepatitis C was the most prevalent etiology of cirrhosis (38%). Meta-analysis revealed a pooled relative risk of 3.1 (95% CI 1.9% to 5.0%) for post-transplant mortality based on elevated BNP or NT-BNP level. Meta-analysis also revealed a pooled relative risk of 1.6 (95% CI 1.3% to 2.1%) for post-transplant mortality if patients had demonstrated post-transplant heart failure. Conclusions: Our analysis suggests that BNP or NT-BNP measurement may help in risk stratification and provides data on post-operative mortality in cirrhotic patients undergoing liver transplantation. Discriminatory thresholds are higher in cirrhotic patients relative to prior studies with non-cirrhotic patients. However, the number of analyzed studies is limited, and our findings should be validated further through larger, prospective studies.
Background: Cirrhotic patients undergoing liver transplantation are at risk of cardiac complications. Brain natriuretic peptide (BNP) and amino terminal brain natriuretic peptide (NT-BNP) are used in cardiac risk stratification. Their significance in predicting mortality risk in cirrhotic patients during or after liver transplantation is unknown. We conducted a systematic review and meta-analysis to answer this question. Methods: An electronic search of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (2005-September 2016), Google Scholar, and study bibliographies was conducted. Study quality was determined, and demographic and outcome data were gathered. Random effects meta-analyses of mortality-based BNP and NT-BNP level or presence of post-transplant heart failure were conducted. Results: Seven studies including 2,010 patients were identified. Demographics were similar between patients with high or low BNP or NT-BNP levels. Hepatitis C was the most prevalent etiology of cirrhosis (38%). Meta-analysis revealed a pooled relative risk of 3.1 (95% CI 1.9% to 5.0%) for post-transplant mortality based on elevated BNP or NT-BNP level. Meta-analysis also revealed a pooled relative risk of 1.6 (95% CI 1.3% to 2.1%) for post-transplant mortality if patients had demonstrated post-transplant heart failure. Conclusions: Our analysis suggests that BNP or NT-BNP measurement may help in risk stratification and provides data on post-operative mortality in cirrhotic patients undergoing liver transplantation. Discriminatory thresholds are higher in cirrhotic patients relative to prior studies with non-cirrhotic patients. However, the number of analyzed studies is limited, and our findings should be validated further through larger, prospective studies.
Authors: Fuat H Saner; Till Neumann; Ali Canbay; Juergen W Treckmann; Matthias Hartmann; Klaus Goerlinger; Stefanie Bertram; Susanne Beckebaum; Vito Cicinnati; Andreas Paul Journal: Transpl Int Date: 2011-01-29 Impact factor: 3.782
Authors: Michael R Charlton; Justin M Burns; Rachel A Pedersen; Kymberly D Watt; Julie K Heimbach; Ross A Dierkhising Journal: Gastroenterology Date: 2011-07-02 Impact factor: 22.682
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Authors: Reitze N Rodseth; Bruce M Biccard; Yannick Le Manach; Daniel I Sessler; Giovana A Lurati Buse; Lehana Thabane; Robert C Schutt; Daniel Bolliger; Lucio Cagini; Daniela Cardinale; Carol P W Chong; Rong Chu; Miłosław Cnotliwy; Salvatore Di Somma; René Fahrner; Wen Kwang Lim; Elisabeth Mahla; Ramaswamy Manikandan; Francesco Puma; Wook B Pyun; Milan Radović; Sriram Rajagopalan; Stuart Suttie; Thuvaraha Vanniyasingam; William J van Gaal; Marek Waliszek; P J Devereaux Journal: J Am Coll Cardiol Date: 2013-09-26 Impact factor: 24.094
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