title: Neutrophil gelatinase-associated lipocalin in kidney transplantation is an early marker of graft dysfunction and is associated with one-year renal function.
abstract: Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been suggested as potential early marker of delayed graft function (DGF) following kidney transplantation (KTx). We conducted a prospective study in 40 consecutive KTx recipients to evaluate serial changes of uNGAL within the first week after KTx and assess its performance in predicting DGF (dialysis requirement during initial posttransplant week) and graft function throughout first year. Urine samples were collected on post-KTx days 0, 1, 2, 4, and 7. Linear mixed and multivariable regression models, receiver-operating characteristic (ROC), and areas under ROC curves were used. At all-time points, mean uNGAL levels were significantly higher in patients developing DGF (n = 18). Shortly after KTx (3-6 h), uNGAL values were higher in DGF recipients (on average +242 ng/mL, considering mean dialysis time of 4.1 years) and rose further in following days, contrasting with prompt function recipients. Day-1 uNGAL levels accurately predicted DGF (AUC-ROC = 0.93), with a performance higher than serum creatinine (AUC-ROC = 0.76), and similar to cystatin C (AUC-ROC = 0.95). Multivariable analyses revealed that uNGAL levels at days 4 and 7 were strongly associated with one-year serum creatinine. Urinary NGAL is an early marker of graft injury and is independently associated with dialysis requirement within one week after KTx and one-year graft function.
authors.affiliation: Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, 4099-001 Porto, Portugal ; Unit for Multidisciplinary Investigation in Biomedicine (UMIB), 4099-003 Porto, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Fonseca
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Oliveira
authors.forename: Manuela
authors.initials: M
authors.lastname: Almeida
authors.forename: Madalena
authors.initials: M
authors.lastname: Cruz
authors.forename: Anabela
authors.initials: A
authors.lastname: Malho
authors.forename: La Salete
authors.initials: LS
authors.lastname: Martins
authors.forename: Leonídio
authors.initials: L
authors.lastname: Dias
authors.forename: Sofia
authors.initials: S
authors.lastname: Pedroso
authors.forename: Josefina
authors.initials: J
authors.lastname: Santos
authors.forename: Luísa
authors.initials: L
authors.lastname: Lobato
authors.forename: António
authors.initials: A
authors.lastname: Castro Henriques
authors.forename: Denisa
authors.initials: D
authors.lastname: Mendonça