title: Neutrophil gelatinase-associated lipocalin associated with irreversibility of pre-liver transplant kidney dysfunction.
abstract: Kidney outcomes in early post-liver transplantation (LT) are crucial for long-term prognosis, but difficult to predict. Among 203 adult LT patients, we studied the value of plasma neutrophil gelatinase-associated lipocalin (NGAL) measured pre-LT for predicting acute kidney injury (AKI), kidney-replacement therapy within three months, and kidney dysfunction at three months post-LT. Glomerular filtration rate (GFR) was estimated by creatinine-based and cystatin C-based equations. Highest NGAL levels were among patients on pre-LT kidney-replacement therapy, whereas NGAL exceeded 200 μg/L in only three (2%) patients with pre-LT GFR >60 mL/min. Pre-LT NGAL >260 μg/L predicted GFR <60 mL/min at three months post-LT (OR 17.8, 95% CI 2.1-153) independently of 19 other variables reflecting recipient characteristics, liver and kidney function, perioperative hemodynamic stress, and immunosuppression. Of 81 patients with pre-LT GFR <60 mL/min, 48% had GFR <60 mL/min at three months, and an NGAL level >260 μg/L predicted this outcome with 90% specificity and 46% sensitivity. NGAL failed to predict post-LT AKI or need for temporary kidney-replacement therapy. In conclusion, NGAL independently predicted irreversibility of pre-LT kidney dysfunction and could thus help in optimizing patient care and in the decision to perform combined liver-kidney transplantation. Pre-LT NGAL was not useful in patients with preserved pre-LT kidney function or in predicting post-LT AKI.
authors.affiliation: Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Aberg
authors.forename: Marko
authors.initials: M
authors.lastname: Lempinen
authors.forename: Maria
authors.initials: M
authors.lastname: Hollmén
authors.forename: Arno
authors.initials: A
authors.lastname: Nordin
authors.forename: Heikki
authors.initials: H
authors.lastname: Mäkisalo
authors.forename: Helena
authors.initials: H
authors.lastname: Isoniemi
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D000209:Acute-Phase Proteins; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008107:Liver Diseases / Q000097:blood / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D017582:Renal Replacement Therapy; D012307:Risk Factors
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D007166:Immunosuppressive Agents; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
keywords: acute tubular necrosis; biomarker; dialysis; hepatorenal syndrome; renal failure