title: Glomerular filtration rate assessment in individuals after orthotopic liver transplantation based on serum cystatin C levels.
abstract: Individuals after orthotopic liver transplantation (OLT) often show renal dysfunction, which may substantially affect the post-OLT course. Renal function after OLT is commonly assessed by means of serum creatinine (S(cr)) concentration or renal creatinine clearance (C(cr)). A glomerular filtration rate (GFR) estimate based on S(cr) level is not accurate enough because even a more marked decrease in GFR need not be associated with an increase in S(cr) level, especially in jaundiced patients. The study intends to try to estimate GFR in individuals after OLT by means of determining serum cystatin C (S(cyst)) concentrations. In 58 individuals (mean age, 49 +/- 7 years; 31 men, 27 women) at various intervals from OLT (mean, 14 +/- 10 months), GFR was estimated by using simultaneous determinations of S(cyst), S(cr), C(cr), and renal inulin clearance (C(in)). In most subjects (91.3%), C(in) was decreased to less than the lower limit of normal (80 mL/min/1.73 m(2)). A significant correlation (r = 0.70; P <.001) was found between 1/S(cyst) and C(in). Receiver operating characteristic analysis was performed on S(cyst) and S(cr) using a C(in) cutoff value of 80 mL/min/1.73 m(2). The area under the curve for S(cyst) was 0.912 +/- 0.044, and that for S(cr), 0.899 +/- 0.049. There was no statistically significant difference between these values. The sensitivity for a S(cyst) level of 1.20 mg/L (upper limit of normal value) to detect a decrease in GFR (measured as C(in)) below the lower limit of normal (80 mL/min/1.73 m(2)) was 96.1%. The sensitivity of S(cyst) level was significantly greater (P <.01) than the sensitivity of S(cr) level for men and at borderline significance for women (P =.05). Findings support the assumption that a S(cyst) level less than 1.2 mg/L indicates with a high degree of probability (P <.001) that GFR is not decreased to less than the normal limit. S(cyst) assessment in individuals after OLT could be proposed as a confirmatory test of a decrease in GFR in individuals with normal S(cr) levels.
authors.affiliation: Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. otto.schuck@medicon.cz
authors.forename: Otto
authors.initials: O
authors.lastname: Schück
authors.forename: Halima
authors.initials: H
authors.lastname: Gottfriedova
authors.forename: Jan
authors.initials: J
authors.lastname: Maly
authors.forename: Antonin
authors.initials: A
authors.lastname: Jabor
authors.forename: Milena
authors.initials: M
authors.lastname: Stollova
authors.forename: Iva
authors.initials: I
authors.lastname: Bruzkova
authors.forename: Jelena
authors.initials: J
authors.lastname: Skibova
authors.forename: Miroslav
authors.initials: M
authors.lastname: Ryska
authors.forename: Julius
authors.initials: J
authors.lastname: Spicak
authors.forename: Pavel
authors.initials: P
authors.lastname: Trunecka
authors.forename: Jana
authors.initials: J
authors.lastname: Novakova
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003404:Creatinine / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007444:Inulin / Q000378:metabolism; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D007444:Inulin; D003404:Creatinine