Prediction of delayed graft function and long-term graft survival by serum and urinary neutrophil gelatinase–associated lipocalin during the early postoperative phase after kidney transplantation

Abstract

Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as an early marker protein for kidney dysfunction in various clinical settings. In this prospective study we evaluated serial changes of serum and urinary NGAL within the first 7 days after kidney transplantation in 170 consecutive recipients. The main focus of this study was to assess the performance of serum and urinary NGAL in the prediction of delayed graft function (DGF) and two-year graft and patient survival. Serum and urine samples of 170 patients undergoing primary kidney transplantation from October 2010 to December 2012 were prospectively collected from day 0 to 7. NGAL was analyzed by ELISA. Multivariate regression models, receiver-operating characteristics (ROC), and areas under ROC curves (AUC) were used to identify predictors of DGF. DGF occurred in 52 patients (30.6%). Serum (AUC = 0.869) and urinary NGAL (AUC = 0.872) on postoperative day (POD) 2 could accurately predict DGF compared to serum creatinine (AUC = 0.619). Multivariate analyses revealed donor age, serum and urinary NGAL significantly associated with DGF (p<0.001). Recipient age was the only significant factor in a cox regression model influencing two-year graft and patient survival. In conclusion, serum and urinary NGAL are early predictors of DGF after kidney transplantation.

The Predictive value of serum NGAL for the diagnosis of Delayed Graft Function in kidney transplantation

“…Furthermore, the ability of creatinine to detect functional impairment is less than 50% (21). Several studies have been evaluated the role of urine or serum NGAL in predicting DGF after kidney transplantation, compare with traditional biomarkers such as serum Cr and urine output (22)(23)(24). Similar to our study they showed that NGAL level was more useful than serum Cr in early predicting DGF.…”

“…Plasma and urine NGAL were evaluated and compare in some studies to investigate their performance to predict DGF (21,22,30). In some studies plasma NGAL showed an obviously higher sensitivity and a slightly higher speci city than those of urine NGAL, which supported the superiority of plasma NGAL over urine NGAL in predicting DGF within 24 hours following kidney transplantation (30).…”

“…Hollmen et al (21) found a higher AUC value of serum NGAL (AUC, 0.85) compared to urine NGAL (AUC, 0.74). However, Maier et al (22) reported higher AUC (0.74) of urine NGAL compare to serum NGAL (0.73) at 24 hour posttransplantation to predict DGF. These contradictory ndings may be due to differences in study designs or related to sample size.…”

Recent Advances on Biomarkers of Early and Late Kidney Graft Dysfunction

“…Increased release from ischemia-injured tubular cells has been proved to discriminate patients at risk for AKI. Blood NGAL (bNGAL)—performed on serum/plasma—and urine NGAL (uNGAL) were shown to predict DGF in the early post-operative period, whereas its meaning as a perfusion fluid biomarker has already been discussed [ 15 , 21 ].…”

Predictors and One-year Outcomes of Patients with Delayed Graft Function after Deceased Donor Kidney Transplantation

“…In a 3-year DCD kidney registry analysis, Lim et al [24] reported that the recipients of DCD kidneys with DGF experienced a higher incidence of acute rejection and overall graft loss. Gill et al [25] observed that the DGF-associated risk of graft failure was greatest in the rst post-transplant year. A meta-analysis by Yarlagadda et al veri ed the association between DGF, acute rejection, and graft survival.…”