title: Serum Neutrophil Gelatinase-Associated Lipocalin and Cystatin C for Assessing Recovery of Graft Function in Patients Undergoing Living-Donor Kidney Transplantation.
abstract: BACKGROUND
  Neutrophil gelatinase-associated lipocalin (NGAL) can be used as an early indicator of acute kidney injury (AKI), and cystatin C is also suggested to be an ideal marker of glomerular filtration rate (GFR), but they were not sufficiently studied in recipients without delayed graft function (DGF) after living-donor kidney transplant (LDKT). The aim of the study is to investigate whether serum NGAL and cystatin C can assess the recovery of renal function after LDKT.
  
  
  METHODS
  49 adult patients that had undergone LDKT between January 2012 and March 2014 were prospectively enrolled. Serum creatinine, NGAL, and cystatin C were measured on day 0-7, day 10, day 14 and month 9 after transplant. Recovery of graft function was evaluated by the time needed to reach eGFR > or = 60 mL/min/1.73 in2 Poor long-term graft outcome was defined as eGFR < 60 mL/min/1.73 M2 at 9 months.
  
  
  RESULTS
  No DGF was recorded. Serum NGAL level decreased to normal earlier than creatinine after transplant. Cystatin C declined rapidly, but still stayed above the normal range. Serum NGAL on day 0 (p = 0.028) and cystatin C on day 2 (p < 0.001) were independent predictors of the time for graft function recovery in multivariate analysis. Compared to recipients with fair long-term graft outcome (eGFR > 60 mL/min/1.73 m2 at 9 months), recipients with poor long-term graft outcome (eGFR < 60 mL/min/1.73 m2 at 9 months) displayed higher serum NGAL on day 2 (p = 0.045), older age (p = 0.002), longer time on dialysis (p = 0.02), and lower donor eGFR (p = 0.045). There were correlations between serum NGAL and eGFR on day 0 and day 2. Correlations between serum cystatin C and eGFR on day 0, day 2, and month 9 were all significant.
  
  
  CONCLUSIONS
  Serum NGAL may be used as an early predictor of recovery of post-transplant graft function after LDKT, but may not be used for real-time assessment of GFR. At the same time, the predictive ability of serum cystatin C needs to be further assessed.
authors.forename: Yi
authors.initials: Y
authors.lastname: Liu
authors.forename: Hai-Xia
authors.initials: HX
authors.lastname: Li
authors.forename: Ze-Wei
authors.initials: ZW
authors.lastname: Ying
authors.forename: Jing-Jing
authors.initials: JJ
authors.lastname: Guo
authors.forename: Chen-Ying
authors.initials: CY
authors.lastname: Cao
authors.forename: Wang
authors.initials: W
authors.lastname: Jia
authors.forename: Hui-Rong
authors.initials: HR
authors.lastname: Yang
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D000209:Acute-Phase Proteins; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002681:China; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins