title: A comparison of alternative serum biomarkers with creatinine for predicting allograft function after kidney transplantation.
abstract: BACKGROUND
  The role of serum cystatin C (Scyc), neutrophil gelatinase-associated lipocalin, and interleukin-18 in predicting early graft function after kidney transplant is poorly defined.
  
  
  METHODS
  We conducted a multicenter prospective cohort study of deceased-donor kidney transplants. We collected serial blood samples for the first 3 days of transplant and monitored need for dialysis within 1 week and graft function at 3 months after transplant.
  
  
  RESULTS
  Among 78 recipients with serum biomarker measurements, 26 had delayed graft function (DGF; hemodialysis within 1 week of transplant). Of those not dialyzed, 29 had slow graft function (serum creatinine [Scr] reduction from transplantation to day 7 <70%), and 23 had immediate graft function (IGF; reduction in Scr ≥70%). Scyc levels were statistically different between groups by the first postoperative day (POD), whereas Scr levels were not. Serum neutrophil gelatinase-associated lipocalin and serum interleukin-18 levels were not different between groups. Scyc on the first POD demonstrated good utility for predicting DGF and non-IGF (DGF or slow graft function) with areas under the receiver-operating characteristic curve of 0.83 and 0.85, respectively. Areas under the receiver-operating characteristic curve for predicting DGF and non-IGF using Scr on the first POD were 0.65 and 0.53, respectively. Substituting Scyc for Scr in a clinical algorithm improved its utility for predicting DGF or non-IGF, with adjusted odds ratios of 2.4 and 3.3 for Scyc levels on the first POD. The change in Scyc during the first POD demonstrated a dose-response relationship with 3-month graft function.
  
  
  CONCLUSIONS
  Scyc outperforms Scr as a predictor of early graft function after deceased-donor kidney transplant.
authors: Section of Nephrology, Department of Medicine, Yale University School of Medicine and the Clinical Epidemiology Research Center, VAMC, New Haven, CT, USA.
authors: Isaac E
authors: IE
authors: Hall
authors: Mona D
authors: MD
authors: Doshi
authors: Emilio D
authors: ED
authors: Poggio
authors: Chirag R
authors: CR
authors: Parikh
mesh_terms: D000209:Acute-Phase Proteins; D000328:Adult; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C / Q000097:blood*; D051799:Delayed Graft Function / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D020382:Interleukin-18 / Q000097:blood; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood; D008297:Male; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000097:blood; D006435:Renal Dialysis; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine