Yoon K C, Lee K-W, Oh S C, Kim H, Kim H-S, Hong S K, Ahn S-W, Yi N-J, Suh K-S
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Transplant Proc. 2018 Dec;50(10):3667-3672. doi: 10.1016/j.transproceed.2018.09.009. Epub 2018 Sep 8.
Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is an early biomarker of renal injury. We examined the feasibility of using uNGAL as an early predictor of renal impairment in patients under calcineurin inhibitors in liver transplant recipients.
From urine samples obtained from liver transplant recipients, the glomerular filtration rate (GFR) at the time of urine sampling was compared with that at 5 to 7 months later. Patients were divided into 3 groups according to initial GFR and then divided into 2 groups according to the uNGAL level of 25 ng/mL. Progression of renal injury (PRI) was defined as a decrease in the GFR of more than 5 mL/min/1.73 m in the mild or moderate groups, or if a normal group patient shifted to the mild or moderate group.
Fifty-one patients were enrolled. The mean uNGAL level was higher in the moderate group than in the normal and mild groups (18.38 ± 14.31 vs 7.74 ± 8.13; P < .01). A proportion of uNGAL-high was also higher in the moderate group than in the mild group (40% vs 5%; P = .03). uNGAL-high was a risk factor for 6-month PRI (odds ratio, 60.375; 95% confidence interval, 1.283-4088.25; P = .037) and 1-year PRI (odds ratio, 21.311; % confidence interval, 0.947-479.578; P = .054).
A uNGAL of >25 ng/mg can be a marker for moderate renal impairment (GFR of 30-59 mL/min/1.73 m) and a predictor of PRI at 6 months in patients using calcineurin inhibitors. Renal protection strategies should be considered in liver transplant recipients with a uNGAL of >25 ng/mg in spot urine sampling.
尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）是肾损伤的早期生物标志物。我们研究了在肝移植受者中，使用uNGAL作为钙调神经磷酸酶抑制剂治疗患者肾功能损害早期预测指标的可行性。
从肝移植受者的尿液样本中，将尿液采样时的肾小球滤过率（GFR）与5至7个月后的GFR进行比较。根据初始GFR将患者分为3组，然后根据uNGAL水平25 ng/mL将其分为2组。肾损伤进展（PRI）定义为轻度或中度组中GFR下降超过5 mL/min/1.73 m²，或者如果正常组患者转变为轻度或中度组。
共纳入51例患者。中度组的平均uNGAL水平高于正常组和轻度组（18.38±14.31 vs 7.74±8.13；P<0.01）。中度组中uNGAL高的比例也高于轻度组（40% vs 5%；P = 0.03）。uNGAL高是6个月PRI的危险因素（比值比，60.375；95%置信区间，1.283 - 4088.25；P = 0.037）和1年PRI的危险因素（比值比，21.311；95%置信区间，0.947 - 479.578；P = 0.054）。
对于使用钙调神经磷酸酶抑制剂的患者，uNGAL>25 ng/mg可作为中度肾功能损害（GFR为30 - 59 mL/min/1.73 m²）的标志物以及6个月时PRI的预测指标。对于随机尿样uNGAL>25 ng/mg的肝移植受者，应考虑采取肾脏保护策略。
