Changes in Plasma Cystatin C after Renal Transplantation and Acute Rejection in Adults

Abstract

Background: Cystatin C has recently been proposed as an alternative marker of glomerular filtration rate. The diagnostic value of plasma cystatin C for the longitudinal assessment of kidney function after renal transplantation, however, has not been addressed. Methods: Renal function was evaluated in 30 adults receiving renal transplants (46 ± 9 years, mean ± SD) and in 56 healthy controls (38 ± 10 years) using cystatin C. Plasma cystatin C was determined daily starting the day of surgery and for 3 weeks after surgery by an immunonephelometric assay. Results: Plasma concentration significantly decreased during the first week (−44% vs −29% for creatinine). Plasma cystatin C correlated with plasma creatinine (r = 0.741; P <0.0001) and the reciprocal of the creatinine clearance estimated by the Cockcroft-Gault formula (r = 0.882; P <0.001). In all three cases of acute renal impairment, the increase in plasma cystatin C values was more prominent than that of creatinine. Conclusions: Plasma cystatin C is an alternative and accurate marker of allograft function in adult transplant patients. Increased sensitivity compared with creatinine for the detection of acute reduction in glomerular filtration rate allows in some cases a more rapid diagnosis of acute rejection or treatment nephrotoxicity.

Serum Cystatin C in Patients with Delayed Graft Function

“…In renal transplant patients, serum CysC concentrations paralleled those of creatinine regardless of graft function (absence or presence of DGF). Consequently, serum CysC and creatinine signifi cantly correlated over the postoperative study period as observed previously in adult renal transplant patients [31] and subjects suffering from chronic renal disease [13]. Some differences, however, were apparent in their respective serum kinetics.…”

“…Earlier detection of renal damage may lead to more effective intervention. In a preliminary study, LeBricon et al [13] fi rst suggested that CysC was more sensitive than SCr for detecting decreases in GFR and delayed graft function in renal transplant patients. As in most studies, serum CysC measurements correlated well with SCr and creatinine clearance (CrCl).…”

Surrogate Markers for Long-Term Renal Allograft Survival

“…Plasma markers for glomerular filtration have been investigated in kidney transplant recipients. Cystatin‐C is an example of a promising marker for glomerular filtration rate (15,16). Calcineurin‐free immunosuppressive therapy in renal transplantation has been associated with better short‐term renal function (17).…”

Evolution of Endpoints for Renal Transplant Outcome

“…Estimation of cystatin C is an alternative marker for evaluating renal function. Cystatin C has been compared with serum creatinine and creatinine clearance in renal transplant recipients (25). Plasma cystatin C correlates with plasma creatinine (r = 0.741, p < 0.0001) and creatinine clearance (r = 0.882, p < 0.001).…”