title: Clusterin in kidney transplantation: novel biomarkers versus serum creatinine for early prediction of delayed graft function.
abstract: OBJECTIVE
  Current methods for rapid detection of delayed graft function (DGF) after kidney transplantation are unreliable. Urinary clusterin is a biomarker of kidney injury but its utility for prediction of graft dysfunction is unknown.
  
  
  METHODS
  In a single-center, prospective cohort study of renal transplant recipients (N=81), urinary clusterin was measured serially between 4 hr and 7 days after transplantation. The utility of clusterin for prediction of DGF (hemodialysis within 7 days of transplantation) was compared with urinary interleukin (IL)-18, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1, serum creatinine, and clinical variables.
  
  
  RESULTS
  At 4 hr after reperfusion, anuria was highly specific, but of low sensitivity for detection of DGF. At 4 hr, receiver operating characteristic analysis suggested that urinary clusterin, IL-18, kidney injury molecule-1, and NGAL concentration were predictive of DGF. After adjusting for preoperative clinical variables and anuria, clusterin and IL-18 independently enhanced the clinical model for prediction of DGF. Kidney injury molecule-1 only modestly improved the prediction of DGF, whereas NGAL, serum creatinine, and the creatinine reduction ratio did not improve on the clinical model. At 12 hr, the creatinine reduction ratio independently predicted DGF.
  
  
  CONCLUSIONS
  Both urinary clusterin and IL-18 are useful biomarkers and may allow triaging of patients with DGF within 4 hr of transplantation. Relative performance of biomarkers for prediction of graft function is time-dependant. Early and frequent measurements of serum creatinine and calculation of the creatinine reduction ratio also predict DGF within 12 hr of reperfusion.
authors.affiliation: 1 Department of Nephrology, Prince of Wales Hospital, Sydney, Australia. 2 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia. 3 Christchurch Kidney Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand. 4 Clinical Pharmacology, University of Sydney, Sydney, Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Pianta
authors.forename: Philip W
authors.initials: PW
authors.lastname: Peake
authors.forename: John W
authors.initials: JW
authors.lastname: Pickering
authors.forename: Michaela
authors.initials: M
authors.lastname: Kelleher
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Buckley
authors.forename: Zoltan H
authors.initials: ZH
authors.lastname: Endre
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine; D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood / Q000652:urine; D051152:Clusterin / Q000097:blood*; D003404:Creatinine / Q000652:urine*; D051799:Delayed Graft Function / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000628:therapy / Q000652:urine*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D020382:Interleukin-18 / Q000652:urine; D016030:Kidney Transplantation / Q000009:adverse effects*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine; D012372:ROC Curve; D006435:Renal Dialysis; D013997:Time Factors
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C495242:CLU protein, human; D051152:Clusterin; C000589760:IL18 protein, human; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine