Fonseca Isabel, Oliveira José Carlos, Almeida Manuela, Cruz Madalena, Malho Anabela, Martins La Salete, Dias Leonídio, Pedroso Sofia, Santos Josefina, Lobato Luísa, Castro Henriques António, Mendonça Denisa
Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, Hospital de Santo António, 4099-001 Porto, Portugal ; Unit for Multidisciplinary Investigation in Biomedicine (UMIB), 4099-003 Porto, Portugal.
J Transplant. 2013;2013:650123. doi: 10.1155/2013/650123. Epub 2013 Oct 31.
Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been suggested as potential early marker of delayed graft function (DGF) following kidney transplantation (KTx). We conducted a prospective study in 40 consecutive KTx recipients to evaluate serial changes of uNGAL within the first week after KTx and assess its performance in predicting DGF (dialysis requirement during initial posttransplant week) and graft function throughout first year. Urine samples were collected on post-KTx days 0, 1, 2, 4, and 7. Linear mixed and multivariable regression models, receiver-operating characteristic (ROC), and areas under ROC curves were used. At all-time points, mean uNGAL levels were significantly higher in patients developing DGF (n = 18). Shortly after KTx (3-6 h), uNGAL values were higher in DGF recipients (on average +242 ng/mL, considering mean dialysis time of 4.1 years) and rose further in following days, contrasting with prompt function recipients. Day-1 uNGAL levels accurately predicted DGF (AUC-ROC = 0.93), with a performance higher than serum creatinine (AUC-ROC = 0.76), and similar to cystatin C (AUC-ROC = 0.95). Multivariable analyses revealed that uNGAL levels at days 4 and 7 were strongly associated with one-year serum creatinine. Urinary NGAL is an early marker of graft injury and is independently associated with dialysis requirement within one week after KTx and one-year graft function.
尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）被认为是肾移植（KTx）后移植肾功能延迟恢复（DGF）的潜在早期标志物。我们对40例连续的KTx受者进行了一项前瞻性研究，以评估KTx后第一周内uNGAL的系列变化，并评估其在预测DGF（移植后初始周内的透析需求）和整个第一年移植肾功能方面的表现。在KTx术后第0、1、2、4和7天收集尿液样本。使用线性混合和多变量回归模型、受试者工作特征（ROC）曲线及ROC曲线下面积。在所有时间点，发生DGF的患者（n = 18）的平均uNGAL水平显著更高。KTx后不久（3 - 6小时），DGF受者的uNGAL值更高（考虑平均透析时间为4.1年，平均升高242 ng/mL），且在随后几天进一步升高，这与移植肾功能迅速恢复的受者形成对比。术后第1天的uNGAL水平能准确预测DGF（AUC-ROC = 0.93），其预测性能高于血清肌酐（AUC-ROC = 0.76），与胱抑素C相似（AUC-ROC = 0.95）。多变量分析显示，术后第4天和第7天的uNGAL水平与一年时的血清肌酐密切相关。尿NGAL是移植肾损伤的早期标志物，并且与KTx后一周内的透析需求及一年时的移植肾功能独立相关。
