title: Plasma NGAL and glomerular filtration rate in cardiac transplant recipients treated with standard or reduced calcineurin inhibitor levels.
abstract: OBJECTIVE
  Predictors of renal recovery following conversion from calcineurin inhibitor- to proliferation signal inhibitor-based therapy are lacking. We hypothesized that plasma NGAL (P-NGAL) could predict improvement in glomerular filtration rate (GFR) after conversion to everolimus.
  
  
  METHODS
  P-NGAL was measured in 88 cardiac transplantation patients (median 5 years post-transplant) with renal dysfunction randomized to continuation of conventional calcineurin inhibitor-based immunosuppression or switching to an everolimus-based regimen.
  
  
  RESULTS
  P-NGAL correlated with measured GFR (mGFR) at baseline (R(2) = 0.21; p < 0.001). Randomization to everolimus improved mGFR after 1 year (median [25-75 % percentiles]: ΔmGFR 5.5 [-0.5-11.5] vs -1 [-7-4] ml/min/1.73 m(2); p = 0.006). Baseline P-NGAL predicted mGFR after 1 year (R(2) = 0.18; p < 0.001), but this association disappeared after controlling for baseline mGFR.
  
  
  CONCLUSIONS
  P-NGAL and GFR correlate with renal dysfunction in long-term heart transplantation recipients. P-NGAL did not predict improvement of renal function after conversion to everolimus-based immunosuppression.
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. finng@dadlnet.dk.
authors: Finn
authors: F
authors: Gustafsson
authors: Einar
authors: E
authors: Gude
authors: Vilborg
authors: V
authors: Sigurdardottir
authors: Pål
authors: P
authors: Aukrust
authors: Dag
authors: D
authors: Solbu
authors: Jens-Peter
authors: JP
authors: Goetze
authors: Lars
authors: L
authors: Gullestad
mesh_terms: D000209:Acute-Phase Proteins; D000368:Aged; D019703:Calcineurin / Q000378:metabolism; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy* / Q000517:prevention & control; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011518:Proto-Oncogene Proteins / Q000097:blood*; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000209:Acute-Phase Proteins; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D000068338:Everolimus; D003404:Creatinine; D019703:Calcineurin; D020123:Sirolimus