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. Methods and 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. Conclusion 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.