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 6 123 ng/mL) than patients without AKI (95 6 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 (DsCr). Plasma MIF (P 5 0.02) and DsCr (P 5 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 DsCr. Plasma MIF had a better predictive value than sCr for the requirement of RRT (P 5 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. Liver Transpl 21:662-669, 2015. V C 2015 AASLD.

Graft‐derived macrophage migration inhibitory factor correlates with hepatocellular injury in patients undergoing liver transplantation

“…We recently demonstrated that systemic MIF concentrations increase after reperfusion in patients undergoing OLT . In agreement with our previous findings, MIF concentrations increased in the serum of patients undergoing OLT after reperfusion in this study.…”

“…demonstrated a close relation between concentrations of MIF in serum with markers of cellular damage such as ALT, AST, and LDH in patients after cardiac arrest . Recently, we found that elevated MIF concentrations after OLT were associated with postoperative acute kidney injury . In the current study, we report an association between MIF and postoperative liver graft function.…”

“…In addition, systemic MIF concentrations increased after liver transplantation in rats . We have previously reported that systemic MIF concentrations increased after reperfusion in patients undergoing OLT . However, the role of MIF in human hepatic I/R remains unknown.…”

D-dopachrome tautomerase predicts outcome but not the development of acute kidney injury after orthotopic liver transplantation

“…In addition, postoperative kidney function was assessed according to the KDIGO criteria, 20 and patients were assigned to the 'no/mild AKI' (no AKI and stage 1 AKI) and 'severe AKI' (stage 2 and 3 AKI) group, as previously described. 21,22 Sample collection and analysis Blood samples were collected from an arterial line at following time points: at baseline after induction of anesthesia, at the end of OLT (End OLT), and on the morning of the first, second, and third postoperative day (POD1, POD2, and POD3, respectively). Immediately after collection, serum samples were allowed to set for 30 min, centrifuged at 2600 g for 15 min, and stored at −80 C until analysis.…”

Pre‐operative anaemia and postoperative acute kidney injury in liver transplantation: valuable but there are still some unanswered questions. A reply

“…Some studies have shown an association between pre‐operative serum creatinine and concordant MELD score with post‐liver transplantation AKI, whereas others have not . Furthermore, as serum creatinine has been shown to overestimate the glomerular filtration rate in cirrhotic patients, it is an inaccurate marker for renal function in this patient population . Thus, we deliberately decided not to include pre‐operative serum creatinine as an individual parameter in this analysis.…”