The assessment of GFR after orthotopic liver transplantation using cystatin C and creatinine-based equations

Wagner, Doris; Kniepeiss, Daniela; Stiegler, Philipp; Zitta, Sabine; Bradatsch, Andrea; Robatscher, Markus; Müller, Heimo; Meinitzer, Andreas; Fahrleitner‐Pammer, Astrid; Wirnsberger, Gerhard; Iberer, F.; Tscheliessnigg, Karlheinz; Reibnegger, Gilbert; Rosenkranz, Alexander R.

doi:10.1111/j.1432-2277.2012.01449.x

Cited by 34 publications

(18 citation statements)

References 45 publications

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“…Similar observations have been published for cystatin C in the setting of kidney transplantation [17,21] being superior to creatinine in detecting changes in kidney function. However, other studies failed to show superiority of cystatin C as well as NGAL over creatinine in reflecting renal function in different settings [22,23,24,25,26]. Additionally, cystatin C concentrations were observed to rise again in the postoperative period after renal transplantation independently from renal function [21,27], therefore limiting its use under these clinical circumstances.…”

Section: Discussionmentioning

confidence: 99%

C-Terminal Agrin Fragment - A New Fast Biomarker for Kidney Function in Renal Transplant Recipients

Steubl¹,

Hettwer²,

Dahinden³

et al. 2013

Am J Nephrol

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Background: The C-terminal agrin fragment (CAF) is a cleavage product of agrin, the major proteoglycan of the glomerular basement membrane. This article studies if CAF could serve as a biomarker for renal function in renal transplant recipients. Material and Methods: We measured serum CAF and creatinine concentrations and calculated estimated glomerular filtration rate (eGFR) (MDRD) in 96 healthy individuals and in 110 end-stage renal disease patients undergoing kidney transplantation before and after transplantation. Correlation between CAF and creatinine concentrations/eGFR was calculated as within-patient (cWP) and between-patient correlations (cBP). Moreover, we evaluated the association of CAF with delayed graft function (DGF). The diagnostic value of CAF for early detection of DGF compared to creatinine was evaluated by receiver operating characteristics (ROC) analysis. Results: CAF concentrations strongly correlated with creatinine (r = 0.86 (cWP), r = 0.74 (cBP)) and eGFR (MDRD) (r = 0.86 (cWP), r = 0.77 (cBP)). Pre-transplant (pre-Tx) CAF concentrations were 19-fold higher than in healthy individuals (1,115.0 (258.4-3,990.0) vs. 56.6 (20.0-109.5) pM). After transplantation, CAF decreased significantly faster than creatinine (postoperative days 1-3 (POD 1-3): 562.8 (101.6-2,113.0) pM; creatinine: pre-Tx 6.9 (3.1-15.7), POD 1-3: 6.4 (1.7-12.7) mg/dl, p < 0.001). Stable concentrations were reached 1-3 months after transplantation for CAF and creatinine (CAF 145.1 (6.7-851.0) pM; creatinine 1.6 (0.7-8.0) mg/dl). CAF concentrations at POD 1-3 were significantly associated with DGF and outperformed creatinine in early detection of DGF (area under the curve (AUC) CAF 80.7% (95% CI 72.3-89.1%) vs. AUC creatinine 71.3% (95% CI 61.8-81.1%), p = 0.061). Conclusion: CAF is a promising new and fast biomarker for kidney function and may serve as a new tool for the early detection of DGF.

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Section: Discussionmentioning

confidence: 99%

C-Terminal Agrin Fragment - A New Fast Biomarker for Kidney Function in Renal Transplant Recipients

Steubl¹,

Hettwer²,

Dahinden³

et al. 2013

Am J Nephrol

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“…They proposed that a score including true GFR instead of serum creatinine would be more accurate in predicting early mortality in patients with cirrhosis awaiting for OLT [27]. Recently Wagner et al demonstrated that cystatin C based equations were superior than creatinine for predicting renal dysfunction after OLT [28].…”

Section: Discussionmentioning

confidence: 99%

Role of MELD Score and Serum Creatinine as Prognostic Tools for the Development of Acute Kidney Injury after Liver Transplantation

et al. 2013

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BackgroundThe role of the Model for End-Stage Liver Disease (MELD) score in predicting complications, such as Acute Kidney Injury (AKI), after orthotopic liver transplantation (OLT) has yet to be evaluated and serum creatinine may be too heavily weighted in the existing MELD formula, since it has many pitfalls in cirrhotic patients.MethodsRetrospective data of the perioperative period from consecutive adult OLTs performed from January to December 2009 were recorded. Univariate and multivariate analysis were performed to analyze the risk factors for AKI and mortality after OLT.ResultsThere were 114 OLTs performed in the study period, 22 (19,2%) were submitted to dialysis prior OLT and were excluded from the analysis for AKI. The median age was 52 years and 66% were male. Median creatinine value was 0.85mg/dL and MELD was 19. Fifty-two of the 92 patients (56,5%) developed AKI in the first 72 hours after OLT. The only independent risk factor for AKI was calculated MELD and when the components of the MELD score were analyzed, INR had a much stronger impact in predicting AKI then serum creatinine. Overall mortality rate was 32,5% and anesthesia duration was the only variable associated with higher mortality rate.ConclusionsAlthough MELD score seems to have a good performance in predicting AKI after OLT, serum creatinine had no impact on its prediction despite its importance on MELD calculation. Modifying the MELD score, which could include novel AKI biomarkers, may improve its prognostic accuracy and provide a better tool for public health planning.

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“…Unlike creatinine, serum cystatin C is independent of muscle mass, age and gender, and is not influenced by serum bilirubin or malignancy [10,11,13,16]. In cirrhosis, cystatin C has been considered a more sensitive indicator of renal function compared to creatinine [17,18,19,20,21,22,23,24]. However, cystatin C was also shown to be influenced by other factors than GFR, such as high C-reactive protein and white blood cell count or low serum albumin, which are frequently present in cirrhosis and consequently impair the reliability of cystatin C-based equations [25].…”

Section: The Kidney In Liver Diseasementioning

confidence: 99%

Bile Acid-Induced Cholemic Nephropathy

Krones¹,

Wagner²,

Eller

et al. 2015

Dig Dis

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Kidney injury in deeply jaundiced patients became known as cholemic nephropathy. This umbrella term covers impaired renal function in cholestatic patients with characteristic histomorphological changes including intratubular cast formation and tubular epithelial cell injury. Cholemic nephropathy represents a widely underestimated but important cause of kidney dysfunction in patients with cholestasis and advanced liver disease. However, the nomenclature is inconsistent since there are numerous synonyms used; the underlying mechanisms of cholemic nephropathy are not entirely clear, and widely accepted diagnostic criteria are still missing. Consequently, the current article aims to summarize the present knowledge on the clinical and morphological characteristics, available preclinical models, derived potential pathomechanisms, and future diagnostic and therapeutic strategies in cholemic nephropathy. Furthermore, we provide a potential research agenda for this evolving field.

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The assessment of GFR after orthotopic liver transplantation using cystatin C and creatinine-based equations

Cited by 34 publications

References 45 publications

C-Terminal Agrin Fragment - A New Fast Biomarker for Kidney Function in Renal Transplant Recipients

C-Terminal Agrin Fragment - A New Fast Biomarker for Kidney Function in Renal Transplant Recipients

Role of MELD Score and Serum Creatinine as Prognostic Tools for the Development of Acute Kidney Injury after Liver Transplantation

Bile Acid-Induced Cholemic Nephropathy

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