title: Serum Cystatin C as an Indicator of Renal Function and Mortality in Liver Transplant Recipients.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) is an important comorbidity after liver transplantation (LT); however, reliable tools with which to evaluate these patients are limited. In this work, we examine the extent to which the addition of serum cystatin C improves glomerular filtration rate (GFR) estimation and mortality prediction, in comparison to various GFR-estimating equations.
  
  
  METHODS
  The GFR was measured in LT recipients by iothalamate clearance. Concurrent serum cystatin C was assayed in banked serum samples. Performance of GFR-estimating equations with and without cystatin C, including the modification of diet in renal disease and CKD-epidemiology collaboration formulas was assessed. The proportional hazards regression analysis was performed to determine the association between serum cystatin C and mortality.
  
  
  RESULTS
  A total of 586 iothalamate results were obtained in 401 patients after a mean of 4 years after LT. When compared to measured GFR, the formula with both creatinine and cystatin C, namely, CKD-epidemiology cr-cys, outperformed those with either marker alone. Performance of creatinine-based models was similar to one another. Serum cystatin C, by itself or as a part of an estimated GFR, was a significant predictor of mortality.
  
  
  CONCLUSIONS
  Serum cystatin C has an important role in enhancing accuracy of GFR estimation and predicting mortality in LT recipients.
authors: 1 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. 2 Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA. 3 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. 4 Division of Nephrology, Mayo Clinic, Rochester, MN.
authors: Alina M
authors: AM
authors: Allen
authors: W Ray
authors: WR
authors: Kim
authors: Joseph J
authors: JJ
authors: Larson
authors: Colin
authors: C
authors: Colby
authors: Terry M
authors: TM
authors: Therneau
authors: Andrew D
authors: AD
authors: Rule
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine
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