High Urinary Aspartate Aminotransferase in the Late Posttransplant Period Predicts Rapid, Progressive Decline in Kidney Allograft Function.
OBJECTIVE
Scant information is available on factors for predicting the rate of decline in kidney allograft function beyond 1 year posttransplant.We investigated whether urinary enzymes (alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, N-acetyl-β-D-hexosaminidase, and ε-glutamyl transpeptidase) in the late postoperative period can predict the decline in estimated glomerular filtration rate.


METHODS
In 79 kidney allograft recipients 1 to 17 years after kidney transplant, we assessed a value of urinary enzymes single measurement for predicting the slope of estimated glomerular filtration rate, rapid decline in estimated glomerular filtration rate (> 5 mL/min/1.73 m² /y), and significant decline in estimated glomerular filtration rate (≥ 25% from baseline) during a 2-year period.


RESULTS
At baseline, patients with estimated glomerular filtration rate < 60 mL/min/1.73 m² (n = 54) differed from those with estimated glomerular filtration rate ≥ 60 mL/min/1.73 m² (n = 25) only in their lower median urinary alanine aminotransferase:creatinine ratio (expressed as U/L:mmol/L): 0.055 versus 0.222 (P = .011). Higher urinary activity of aspartate aminotransferase at baseline predicted the negative-slope value for estimated glomerular filtration rate (beta, -0.279; standard error, 0.131; P = .037) and decline in estimated glomerular filtration rate of > 5 mL/min/1.73 m ²/year (odds ratio, 2.06; 95% confidence interval, 1.10-3.83; P = .023) over 2 years. It also predicted the drop in estimated glomerular filtration rate ≥ 25% after 1 year (odds ratio, 2.62; 95% confidence interval, 1.07-6.37; P = .034) and 2 years (odds ratio, 2.75; 95% confidence interval, 1.12-6.73; P =.027). Combined with time after transplant, urinary aspartate aminotransferase had good power for predicting an estimated glomerular filtration rate decrease ≥ 25% after 2 years of follow-up.


CONCLUSIONS
Higher urinary activity of aspartate aminotransferase in the late posttransplant period is useful for identifying transplant patients who are at risk for progressive loss of graft function.
Department of Laboratory Diagnostics and General, Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine, Zaporizhzhia Regional Hospital, Zaporizhzhia, Ukraine.
Andriy V
AV
Trailin
Marina V
MV
Pleten
Tatiana I
TI
Ostapenko
Nadia F
NF
Iefimenko
Olexander S
OS
Nikonenko
D000293:Adolescent; D000328:Adult; D064591:Allografts; D001219:Aspartate Aminotransferases / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D004796:Clinical Enzyme Tests; D003404:Creatinine / Q000652:urine; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000652:urine; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D016482:Urinalysis; D055815:Young Adult
D015415:Biomarkers; D003404:Creatinine; D001219:Aspartate Aminotransferases