title: Leptin and adiponectin during the first week after kidney transplantation: biomarkers of graft dysfunction?
abstract: OBJECTIVE
  Based on evidence that leptin and adiponectin are removed from circulation primarily by the kidney, we designed a study to examine the longitudinal changes of these adipokines during the first week after kidney transplantation (KTx) and to test the hypothesis that higher levels of leptin and/or adiponectin could be early biomarkers of delayed graft function (DGF=dialysis requirement during the first post-transplant week) and acute rejection.
  
  
  METHODS
  Repeated-measures prospective study.
  
  
  METHODS
  Forty consecutive adult patients with end-stage renal disease who were undergoing KTx. Leptin and adiponectin were measured in blood samples that were collected before (day-0) and after KTx (days-1, 2, 4 and 7). Linear mixed-models, receiver operating characteristic and area under curve (AUC-ROC) were used.
  
  
  RESULTS
  At post-transplant day-1, leptinemia and adiponectinemia declined 43% and 47%, respectively. At all times studied after KTx, the median leptin levels were significantly higher in patients developing DGF (n=18), but not adiponectin levels. Shortly after KTx (day-1), leptin values were significantly higher in DGF recipients in contrast to patients with promptly functioning kidneys, approximately two times higher when controlling for gender and BMI. The leptin reduction rate between pre-tranplant and one-day after KTx moderately predicted DGF (AUC=0.73). On day-1, serum leptin predicted DGF (AUC-ROC=0.76) with a performance slightly better than serum creatinine (AUC-ROC=0.72), even after correcting for BMI (AUC-ROC=0.73). Separating this analysis by gender showed that the performance of leptin in predicting DGF for male gender (AUC-ROC=0.86) improved.
  
  
  CONCLUSIONS
  Kidney graft function is an independent determinant of leptin levels, but not of adiponectin. Leptin levels at day-1 slightly outperformed serum creatinine in predicting the occurrence of DGF, and more accurately in male gender. No significant association was detected with acute rejection.
authors.affiliation: Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal; Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal; Institute of Public Health (ISPUP), University of Porto, Porto, Portugal. Electronic address: isabelf27@gmail.com.
authors.forename: Isabel
authors.initials: I
authors.lastname: Fonseca
authors.affiliation: Department of Clinical Chemistry, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Oliveira
authors.affiliation: Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal; Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal.
authors.forename: Josefina
authors.initials: J
authors.lastname: Santos
authors.affiliation: Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal; Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Malheiro
authors.affiliation: Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal; Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal.
authors.forename: La Salete
authors.initials: LS
authors.lastname: Martins
authors.affiliation: Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal; Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal.
authors.forename: Manuela
authors.initials: M
authors.lastname: Almeida
authors.affiliation: Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
authors.forename: Leonídio
authors.initials: L
authors.lastname: Dias
authors.affiliation: Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal; Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Pedroso
authors.affiliation: Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal; Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal.
authors.forename: Luísa
authors.initials: L
authors.lastname: Lobato
authors.affiliation: Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal; Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Porto, Portugal.
authors.forename: António Castro
authors.initials: AC
authors.lastname: Henriques
authors.affiliation: Department of Population Studies, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal; Institute of Public Health (ISPUP), University of Porto, Porto, Portugal.
authors.forename: Denisa
authors.initials: D
authors.lastname: Mendonça
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D051799:Delayed Graft Function / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D042241:Early Diagnosis; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects*; D020738:Leptin / Q000097:blood*; D008297:Male; D011174:Portugal; D011184:Postoperative Period; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015854:Up-Regulation
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers; D020738:Leptin
keywords: Adipokines; Adiponectin; Delayed graft function; Kidney transplantation; Leptin