Purpose: Nesiritide (rhBNP), B-type natriuretic peptide is known to reduce endothelin levels, cause afferent arteriole vasodilatation, increase natriuresis & diuresis. We hypothesize that rhBNP infusion has renoprotective properties in early post- heart transplant (HT) patients (pts) with acute kidney injury (AKI).

Methods: Retrospective analysis of 159 HT pts from 2009 to 2011. AKI was defined as ≥ 0.3 mg/dL or ≥ 50% increase in serum creatinine (SCr) from baseline.

Results: 32 (20%) HT pts who had AKI within 6 days of HT unresponsive to diuretics and received either rhBNP alone or rhBNP + diuretic were included. Demographics, ischemic time, and risk factors were similar. rhBNP was initiated between 1-7 days post-HT when SCr had increased 52% – 297% from baseline (mean SCr 2.7±0.9 mg/dL) and estimated GFR ≤ 60 mL/min/1.73 m². rhBNP infusion dose ranged from 0.001 – 0.04mcg/kg/min. Mean duration of rhBNP in both groups was 9 days & mean SCr upon discontinuation was 1.8 ± 0.8mg/dL. 27 (84%) responded to rhBNP ± intravenous (IV) diuretic, while 5 out of 32 (16%) oligoanuric HT (urine output 3.75 ± 16.25 ml/hr) pts required renal replacement therapy (RRT). At 6 months follow-up no patients were on RRT.

Conclusions: Renoprotective properties of rhBNP was effective when given early post-HT in oliguric AKI pts and was not associated with worsening renal function. However, those who were oligoanuric prior to initiation of rhBNP ended up requiring RRT. rhBNP can be considered as one of the renal optimization strategies in AKI post-HT.

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