Human B-natriuretic peptide improves hemodynamics and renal function in heart transplant patients immediately after surgery.
BACKGROUND
B-natriuretic peptide (BNP) is effective in the treatment of decompensated heart failure, but has not specifically been evaluated in the immediate postoperative cardiac transplant population.


OBJECTIVE
To determine if BNP can favorably alter hemodynamics in the perioperative setting after heart transplantation.


RESULTS
We administered (human)BNP ((h)BNP, Nesiritide) to 10 consecutive patients with preexisting renal insufficiency and elevated filling pressures. All patients had failed to respond to inotropes and escalating doses of diuretics. BNP was started 48 hours after transplantation, and continued for 48 to 72 hours. Intravascular hemodynamics were measured. With (h)BNP therapy, the pulmonary capillary wedge pressure, central venous pressure, and mean pulmonary artery pressure were all attenuated, whereas the cardiac output was significantly increased. The mean urine output increased significantly in the first 24 hours of therapy with no increase in diuretics. Implementation of BNP therapy allowed for a reduction of patients' inotropes and diuretics, while decreasing serum BNP levels.


CONCLUSIONS
An improvement in cardiac hemodynamics and renal function was observed with administration of (h)BNP in these postsurgical patients with elevated filling pressures and acute on chronic renal insufficiency. This study demonstrates that posttransplant patients retain the capacity to respond to exogenous BNP immediately after surgery.
Feldman
David S
DS
Division of Cardiology (Department of Medicine), Medical University of South Carolina, Charleston, South Carolina, USA.
Ikonomidis
John S
JS
Uber
Walter E
WE
Van Bakel
Adrian B
AB
Pereira
Naveen L
NL
Crumbley
Arthur J
AJ
Tann
Stephen M
SM
D058186:Acute Kidney Injury / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output / Q000187:drug effects; D003131:Combined Modality Therapy; D004231:Diuresis / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy; D016027:Heart Transplantation; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D045283:Natriuretic Agents / Q000378:metabolism / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000378:metabolism / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects
D015415:Biomarkers; D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain