title: Macrophage migration inhibitory factor as a potential predictor for requirement of renal replacement therapy after orthotopic liver transplantation.
abstract: Acute kidney injury (AKI) after orthotopic liver transplantation (OLT) is associated with a poor clinical outcome. Because there is no specific treatment for postoperative AKI, early recognition and prevention are fundamental therapeutic approaches. Concentrations of the proinflammatory cytokine macrophage migration inhibitory factor (MIF) are elevated in patients with kidney disease. We hypothesized that plasma MIF concentrations would be greater in patients developing AKI after OLT compared with patients with normal kidney function. Twenty-eight patients undergoing OLT were included in the study. Kidney injury was classified according to AKI network criteria. Fifteen patients (54%) developed severe AKI after OLT, 11 (39%) requiring renal replacement therapy (RRT). On the first postoperative day, patients with severe AKI had greater plasma MIF concentrations (237 ± 123 ng/mL) than patients without AKI (95 ± 63 ng/mL; P < 0.001). The area under the receiver operating characteristic (ROC) curve for predicting severe AKI was 0.87 [95% confidence interval (CI), 0.69-0.97] for plasma MIF, 0.61 (95% CI, 0.40-0.79) for serum creatinine (sCr), and 0.90 (95% CI, 0.72-0.98) for delta serum creatinine (ΔsCr). Plasma MIF (P = 0.02) and ΔsCr (P = 0.01) yielded a better predictive value than sCr for the development of severe AKI. Furthermore, the area under the ROC curve to predict the requirement of RRT was 0.87 (95% CI, 0.68-0.96) for plasma MIF, 0.65 (95% CI, 0.44-0.82) for sCr, and 0.72 (95% CI, 0.52-0.88) for ΔsCr. Plasma MIF had a better predictive value than sCr for the requirement of RRT (P = 0.02). In conclusion, postoperative plasma MIF concentrations were elevated in patients who developed severe AKI after OLT. Furthermore, plasma MIF concentrations showed a good prognostic value for identifying patients developing severe AKI or requiring postoperative RRT after OLT.
authors.affiliation: Department of Anesthesia, General Intensive Care, and Pain Management, Medical University of Vienna, Vienna, Austria.
authors.forename: Joanna
authors.initials: J
authors.lastname: Stefaniak
authors.forename: Judith
authors.initials: J
authors.lastname: Schiefer
authors.forename: Edmund John
authors.initials: EJ
authors.lastname: Miller
authors.forename: Claus Georg
authors.initials: CG
authors.lastname: Krenn
authors.forename: David Marek
authors.initials: DM
authors.lastname: Baron
authors.forename: Peter
authors.initials: P
authors.lastname: Faybik
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000601:surgery; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D019746:Intramolecular Oxidoreductases / Q000097:blood; D016031:Liver Transplantation / Q000009:adverse effects*; D008263:Macrophage Migration-Inhibitory Factors / Q000097:blood; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D051437:Renal Insufficiency / Q000601:surgery; D017582:Renal Replacement Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D008263:Macrophage Migration-Inhibitory Factors; D003404:Creatinine; D019746:Intramolecular Oxidoreductases; C515598:MIF protein, human