Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York, NY.
Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY.
Transplantation. 2018 May;102(5):809-815. doi: 10.1097/TP.0000000000002075.
Urinary neutrophil gelatinase-associated lipocalin (uNGAL)-associated acute kidney injury is common after liver transplantation (LT), but whether early acute kidney injury predicts chronic kidney disease (CKD) and mortality remains uncertain.
Adults with LT from 2008 to 2010 in a previously published prospective cohort evaluating serial uNGAL pre- and post-LT were retrospectively assessed to evaluate uNGAL as a predictor of long-term outcomes post-LT. The primary outcomes were post-LT CKD, defined as Modification of Diet in Renal Disease estimated glomerular filtration rate less than 60 mL/min per 1.73 m for 3 continuous months, and death.
uNGAL at 24 hours postreperfusion was significantly higher among patients who developed CKD. Multivariable modeling for the development of CKD demonstrated that uNGAL at 24-hours postreperfusion, 24 hours post-LT renal function, initial calcineurin inhibitor, and age were independent predictors of the development of CKD at in this cohort with long-term follow-up post-LT. Further, this association was stronger in those with preserved pre-LT renal function, a population where renal outcomes are often difficult to predict.
We propose that perioperative uNGAL may identify patients at risk for CKD and allow for targeted early implementation of renal-sparing strategies.
肝移植（LT）后尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）相关急性肾损伤很常见，但早期急性肾损伤是否预测慢性肾脏病（CKD）和死亡率尚不确定。
对 2008 年至 2010 年期间在先前发表的前瞻性队列中评估 LT 前后连续 uNGAL 的成人进行回顾性评估，以评估 uNGAL 作为 LT 后长期结局的预测因子。主要结局是 LT 后 CKD，定义为改良肾脏病饮食研究估计肾小球滤过率连续 3 个月低于 60 mL/min/1.73 m，以及死亡。
发生 CKD 的患者再灌注后 24 小时的 uNGAL 明显升高。用于 CKD 发生的多变量建模表明，再灌注后 24 小时的 uNGAL、LT 后 24 小时的肾功能、初始钙调神经磷酸酶抑制剂和年龄是该 LT 队列中发生 CKD 的独立预测因子，该队列具有 LT 后长期随访。此外，在那些保留了 LT 前肾功能的患者中，这种关联更强，而在这些患者中，肾脏结局往往难以预测。
我们提出围手术期 uNGAL 可能识别出有 CKD 风险的患者，并允许针对性地早期实施肾脏保护策略。
