title: Cystatin C as a marker of renal function immediately after liver transplantation.
abstract: To verify whether cystatin C may be of some use as a renal function marker immediately after orthotopic liver transplantation (OLT), we compared serum cystatin C (S(Cyst)), serum creatinine (S(cr)), and creatinine clearance (C(cr)) levels with the glomerular filtration rate (GFR). On postoperative days 1, 3, 5, and 7, S(Cyst) and S(cr) was measured in simultaneously drawn blood samples, whereas C(cr) was calculated using a complete 24-hour urine collection. The GFR was determined on the same days by means of iohexol plasma clearance (I-GFR). The correlation between 1/S(Cyst) and I-GFR was stronger than that of 1/S(cr) or C(cr) (P< 0.01). In the case of moderate reductions in I-GFR (80-60 mL/minute/1.73 m), S(cr) remained within the normal range, whereas the increase in S(cyst) was beyond its upper limit; for I-GFR reductions to lower levels (59-40 mL/minute/1.73 m), S(cr) increased slightly, whereas S(cyst) was twice its upper normal limit. When we isolated all of the I-GFR values on days 3, 5, and 7 that were > or = 30% lower than that recorded on the first postoperative day, S(Cyst)(P< 0.0001) and S(cr) (P< 0.01) levels were increased, whereas C(cr) remained unchanged (P = 0.09). Receiver operating characteristic (ROC) area-under-the-curve analysis showed that the diagnostic accuracy of S(cyst) was better than that of S(cr) and C(cr). S(cyst) levels of 1.4, 1.7, and 2.2 mg/L respectively predicted I-GFR levels of 80, 60, and 40 mL/minute/1.73 m. In conclusion, cystatin C is a reliable marker of renal function during the immediate post-OLT period, especially when the goal is to identify moderate changes in GFR.
authors.affiliation: Liver Transplant Anesthesia and Intensive Care Medicine, Ospedale Cisanello, Pisa, Italy. g.biancofiore@med.unipi.it
authors.forename: Gianni
authors.initials: G
authors.lastname: Biancofiore
authors.forename: Laura
authors.initials: L
authors.lastname: Pucci
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cerutti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Penno
authors.forename: Ennia
authors.initials: E
authors.lastname: Pardini
authors.forename: Massimo
authors.initials: M
authors.lastname: Esposito
authors.forename: Lucia
authors.initials: L
authors.lastname: Bindi
authors.forename: Erika
authors.initials: E
authors.lastname: Pelati
authors.forename: Anna
authors.initials: A
authors.lastname: Romanelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Triscornia
authors.forename: Maria P
authors.initials: MP
authors.lastname: Salvadorini
authors.forename: Chiara
authors.initials: C
authors.lastname: Stratta
authors.forename: Giacomo
authors.initials: G
authors.lastname: Lanfranco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellegrini
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Prato
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca
authors.forename: Franco
authors.initials: F
authors.lastname: Filipponi
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C; D015891:Cystatins / Q000032:analysis / Q000378:metabolism*; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007362:Intensive Care Units; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011182:Postoperative Care / Q000379:methods*; D011336:Probability; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine