Liu Yi, Li Hai-Xia, Ying Ze-Wei, Guo Jing-Jing, Cao Chen-Ying, Jia Wang, Yang Hui-Rong
Clin Lab. 2016;62(1-2):155-63. doi: 10.7754/clin.lab.2015.150612.
Neutrophil gelatinase-associated lipocalin (NGAL) can be used as an early indicator of acute kidney injury (AKI), and cystatin C is also suggested to be an ideal marker of glomerular filtration rate (GFR), but they were not sufficiently studied in recipients without delayed graft function (DGF) after living-donor kidney transplant (LDKT). The aim of the study is to investigate whether serum NGAL and cystatin C can assess the recovery of renal function after LDKT.
49 adult patients that had undergone LDKT between January 2012 and March 2014 were prospectively enrolled. Serum creatinine, NGAL, and cystatin C were measured on day 0-7, day 10, day 14 and month 9 after transplant. Recovery of graft function was evaluated by the time needed to reach eGFR > or = 60 mL/min/1.73 in2 Poor long-term graft outcome was defined as eGFR < 60 mL/min/1.73 M2 at 9 months.
No DGF was recorded. Serum NGAL level decreased to normal earlier than creatinine after transplant. Cystatin C declined rapidly, but still stayed above the normal range. Serum NGAL on day 0 (p = 0.028) and cystatin C on day 2 (p < 0.001) were independent predictors of the time for graft function recovery in multivariate analysis. Compared to recipients with fair long-term graft outcome (eGFR > 60 mL/min/1.73 m2 at 9 months), recipients with poor long-term graft outcome (eGFR < 60 mL/min/1.73 m2 at 9 months) displayed higher serum NGAL on day 2 (p = 0.045), older age (p = 0.002), longer time on dialysis (p = 0.02), and lower donor eGFR (p = 0.045). There were correlations between serum NGAL and eGFR on day 0 and day 2. Correlations between serum cystatin C and eGFR on day 0, day 2, and month 9 were all significant.
Serum NGAL may be used as an early predictor of recovery of post-transplant graft function after LDKT, but may not be used for real-time assessment of GFR. At the same time, the predictive ability of serum cystatin C needs to be further assessed.
中性粒细胞明胶酶相关脂质运载蛋白（NGAL）可作为急性肾损伤（AKI）的早期指标，胱抑素C也被认为是肾小球滤过率（GFR）的理想标志物，但在活体肾移植（LDKT）后无移植肾功能延迟恢复（DGF）的受者中，对它们的研究尚不充分。本研究旨在探讨血清NGAL和胱抑素C能否评估LDKT后肾功能的恢复情况。
前瞻性纳入2012年1月至2014年3月间接受LDKT的49例成年患者。在移植后第0 - 7天、第10天、第14天和第9个月测定血清肌酐、NGAL和胱抑素C。通过达到估算肾小球滤过率（eGFR）≥60 mL/min/1.73 m²所需的时间来评估移植肾功能的恢复情况。移植后9个月时eGFR＜60 mL/min/1.73 m²被定义为移植长期预后不良。
未记录到DGF。移植后血清NGAL水平比肌酐更早降至正常。胱抑素C迅速下降，但仍高于正常范围。在多因素分析中，第0天的血清NGAL（p = 0.028）和第2天的胱抑素C（p＜0.001）是移植肾功能恢复时间的独立预测因素。与移植长期预后良好的受者（移植后9个月eGFR＞60 mL/min/1.73 m²）相比，移植长期预后不良的受者（移植后9个月eGFR＜60 mL/min/1.73 m²）在第2天血清NGAL水平更高（p = 0.045）、年龄更大（p = 0.002）、透析时间更长（p = 0.02）、供者eGFR更低（p = 0.045）。第0天和第2天血清NGAL与eGFR之间存在相关性。第0天、第2天和第9个月血清胱抑素C与eGFR之间的相关性均显著。
血清NGAL可作为LDKT后移植肾功能恢复的早期预测指标，但可能不适用于GFR的实时评估。同时，血清胱抑素C的预测能力有待进一步评估。
