title: Urine neutrophil gelatinase-associated lipocalin is a marker of graft recovery after kidney transplantation.
abstract: Delayed graft function (DGF), especially long-lasting DGF, complicates kidney transplant outcome. Neutrophil gelatinase-associated lipocalin (NGAL) is an acute kidney injury marker; therefore, we tested whether urine NGAL could predict DGF, prolonged DGF (lasting over 14 days), or the quality of kidney function in transplant recipients without DGF (non-DGF). We collected urine samples from 176 recipients transplanted with deceased donor kidneys before and various days after transplantation. A total of 70 transplantations had DGF, of which 26 were prolonged. Patients who developed DGF had a significantly slower decrease in urinary NGAL compared with those without DGF, such that day 1 NGAL predicted DGF (area under the curve (AUC) 0.75) and predicted DGF in 15 of 112 cases with day 1 urine output over 1 l (AUC 0.70) and in 19 of 86 cases with a day 1 decrease in creatinine over 50 μmol/l (AUC 0.74). The urinary NGAL level on day 1 predicted prolonged DGF (AUC 0.75), which had significantly worse 1-year graft survival (73%), compared with shorter DGF (100%). In non-DGF, high day 3 NGAL (greater than the mean) was associated with significantly worse kidney function at 3 weeks compared with low NGAL, but not at 3 months and 1 year. NGAL did not correlate with long-term function in DGF. Hence, day 1 urinary NGAL predicted DGF even when it was not clinically expected early on, and importantly, it predicted prolonged DGF that led to worse graft survival.
authors.affiliation: Division of Transplantation, Department of Medicine, Helsinki University Hospital, Helsinki, Finland. maria.hollmen@helsinki.fi
authors.forename: Maria E
authors.initials: ME
authors.lastname: Hollmen
authors.forename: Lauri E
authors.initials: LE
authors.lastname: Kyllönen
authors.forename: Kaija A
authors.initials: KA
authors.lastname: Inkinen
authors.forename: Martti L T
authors.initials: ML
authors.lastname: Lalla
authors.forename: Kaija T
authors.initials: KT
authors.lastname: Salmela
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine*; D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine; D002648:Child; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000175:diagnosis / Q000503:physiopathology / Q000652:urine*; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000502:physiology*; D016030:Kidney Transplantation / Q000502:physiology*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D019737:Transplants; D055815:Young Adult
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine