title: Neutrophil Gelatinase Associated Lipocalin Is an Early and Accurate Biomarker of Graft Function and Tissue Regeneration in Kidney Transplantation from Extended Criteria Donors.
abstract: BACKGROUND
  Delayed graft function (DGF) is an early complication of kidney transplantation (KT) associated with increased risk of early loss of graft function. DGF increases using kidneys from extended criteria donors (ECD). NGAL is a 25KDa protein proposed as biomarker of acute kidney injury. The aim of this study was to investigate the role of NGAL as an early and accurate indicator of DGF and Tacrolimus (Tac) toxicity and as a mediator of tissue regeneration in KT from ECD.
  
  
  METHODS
  We evaluated plasma levels of NGAL in 50 KT patients from ECD in the first 4 days after surgery or after Tac introduction.
  
  
  RESULTS
  Plasma levels of NGAL at day 1 were significantly higher in DGF group. In the non DGF group, NGAL discriminated between slow or immediate graft function and decreased more rapidly than serum creatinine. NGAL increased after Tac introduction, suggesting a role as marker of drug toxicity. In vitro, hypoxia and Tac induced NGAL release from tubular epithelial cells (TEC) favoring an autocrine loop that sustains proliferation and inhibits apoptosis (decrease of caspases and Bax/Bcl-2 ratio).
  
  
  CONCLUSIONS
  NGAL is an early and accurate biomarker of graft function in KT from ECD favoring TEC regeneration after ischemic and nephrotoxic injury.
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cantaluppi
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Dellepiane
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Tamagnone
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Medica
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Figliolini
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Messina
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Manzione
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gai
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Tognarelli
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ranghino
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Dolla
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ferrario
authors.affiliation: EMEALA Medical Board, Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Ciro
authors.initials: C
authors.lastname: Tetta
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Giuseppe Paolo
authors.initials: GP
authors.lastname: Segoloni
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Camussi
authors.affiliation: "A. Vercellone" Kidney Transplantation Center, Department of Medical Sciences, University of Torino, Azienda Ospedaliera "Città della Salute e della Scienza- Molinette", Torino, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Biancone
mesh_terms: D000209:Acute-Phase Proteins / Q000235:genetics; D000368:Aged; D017209:Apoptosis / Q000187:drug effects; D015415:Biomarkers / Q000097:blood; D015687:Cell Hypoxia; D002478:Cells, Cultured; D015331:Cohort Studies; D051799:Delayed Graft Function / Q000097:blood / Q000209:etiology; D046148:Donor Selection; D005260:Female; D015870:Gene Expression; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects; D007684:Kidney Tubules / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood* / Q000235:genetics; D012038:Regeneration; D016559:Tacrolimus / Q000009:adverse effects; D014019:Tissue Donors
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D007166:Immunosuppressive Agents; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D016559:Tacrolimus