title: Serum neutrophil gelatinase-associated lipocalin as a predictor of organ recovery from delayed graft function after kidney transplantation from donors after cardiac death.
abstract: Because of a worldwide shortage of renal grafts, kidneys procured from donors after cardiac death (DCD) have recently become an important source of renal transplants. However, DCD kidneys often have complications with delayed graft function (DGF) and recipients require hemodialysis (HD) in the early period after kidney transplantation (KTx). This study evaluated serum NGAL as a potential specific parameter to predict early functional recovery of transplanted DCD kidneys. The average serum neutrophil gelatinase-associated lipocalin (NGAL) level in normal samples was 53 +/- 30 ng/ml, while that in patients with chronic renal failure requiring HD was markedly raised at 963 +/- 33 ng/ml. In patients undergoing a living-related KTx from a living donor (n=11), serum NGAL level decreased rapidly after KTx, and only in two cases, with serum NGAL levels over 400 ng/ml on postoperative day 1 (POD1), was HD required due to DGF. In contrast, all patients undergoing a KTx from a DCD (n=5) required HD due to DGF. Even in these cases, serum NGAL levels decreased rapidly several days after a KTx prior to the recovery of urine output and preceding the decrease in serum creatinine level. The pattern of decline in serum NGAL was biphasic, the decrease after the second peak indicating a functional recovery within the next several days. These data suggest that monitoring of serum NGAL levels may allow us to predict graft recovery and the need for HD after a KTx from a DCD.
authors.affiliation: Dept. of Urol, Div. of Molecular Genetics, Inst. for Comp. Med. Sci. and 21st Century COE Program, Dev. Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Japan. mkusaka@fujita-hu.ac.jp
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kusaka
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kuroyanagi
authors.forename: Terumi
authors.initials: T
authors.lastname: Mori
authors.forename: Kayuri
authors.initials: K
authors.lastname: Nagaoka
authors.forename: Hitomi
authors.initials: H
authors.lastname: Sasaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Maruyama
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hayakawa
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Shiroki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kurahashi
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Hoshinaga
mesh_terms: D000209:Acute-Phase Proteins; D000328:Adult; D015415:Biomarkers; D003643:Death; D051799:Delayed Graft Function / Q000097:blood* / Q000517:prevention & control; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011518:Proto-Oncogene Proteins / Q000097:blood*; D006435:Renal Dialysis; D014019:Tissue Donors; D009927:Tissue and Organ Procurement
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins