title: Urine liver-type fatty acid-binding protein predicts graft outcome up to 2 years after kidney transplantation.
abstract: BACKGROUND
  Several new biomarkers for the detection of early tubular injury have been investigated in kidney transplant recipients. We recently identified day 2 urinary neutrophil gelatinase-associated lipocalin (NGAL) as a predictor of slow graft function and adverse 1-year outcome. In the present study, we further investigated the value of urinary NGAL and liver-type fatty acid binding protein (L-FABP) for predicting long-term graft outcomes up to 2 years.
  
  
  METHODS
  This study was a single-center, prospective observational study. Serial urinary NGAL and L-FABP levels at 0 hours, 2 days, and 6 days after kidney transplantation (KT) were measured, and the clinical data were assessed during the 2-year period after KT.
  
  
  RESULTS
  During the 2-year follow-up period, 13 (18.8%), 5 (7.2%), and 4 (5.8%) patients were diagnosed with acute T-cell-mediated rejection, acute antibody-mediated rejection (AMR) and chronic AMR, respectively. In addition, 10 patients (14.3%) developed calcineurin inhibitor toxicity and 6 (8.7%) developed BK viremia. The mean estimated glomerular filtration rates (eGFR) at 1 and 2 years after KT were 65.1 ± 19.1 and 58.5 ± 22.6 mL/min/1.73 m(2), respectively, When poor long-term graft function was defined as eGFR of less than 50 mL/min/1.73 m(2) at 2 years, elderly donors, acute rejection, and high 0-hour urinary L-FABP levels were significant risk factors. Furthermore, in rejection-free patients, L-FABP was strongly associated with poor long-term graft function (P = .006). Multivariate logistic regression analysis showed that high 0-hour L-FABP (P = .015) and acute rejection (P = .006) were independent factors predicting poor long-term graft function. Receiver operating characteristic analysis showed that the area under the curve for urinary L-FABP was 0.692 (P = .036).
  
  
  CONCLUSIONS
  Our results suggest that urinary L-FABP may be a useful predictor of adverse long-term outcomes in KT patients.
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: J
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: H M
authors.initials: HM
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: M Y
authors.initials: MY
authors.lastname: Seo
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: K
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
authors.forename: H
authors.initials: H
authors.lastname: Jun
authors.affiliation: Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
authors.forename: C W
authors.initials: CW
authors.lastname: Jung
authors.affiliation: Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
authors.forename: K T
authors.initials: KT
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: M-G
authors.initials: MG
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: S-K
authors.initials: SK
authors.lastname: Jo
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea. Electronic address: wonyong@korea.ac.kr.
authors.forename: W
authors.initials: W
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: H K
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000328:Adult; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; D007166:Immunosuppressive Agents