Medical Surgical Nursing Department, School of Nursing, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
Department of Gastrointestinal Surgery, Clinical Surgery Division, University of Sao Paulo, Sao Paulo, Brazil.
Ren Fail. 2024 Dec;46(2):2402076. doi: 10.1080/0886022X.2024.2402076. Epub 2024 Sep 17.
Renal dysfunction is a common complication following liver transplantation (LT). This study aimed to determine whether a comprehensive assessment of kidney function using nineteen serum and urinary biomarkers (BMs) within the first 48 h post-LT could enhance the prediction of severe acute kidney injury (AKI) and the need of kidney replacement therapy (KRT) during the first postoperative week.
Blood and urine (U) samples were collected during the pre- and postoperative periods. Nineteen BMs were evaluated to assess kidney health in the first 48 h after LT. Classification and regression tree (CART) cross-validation identified key predictors to determine the best BM combination for predicting outcomes.
Among 100 LT patients, 36 developed severe AKI, and 34 required KRT within the first postoperative week. Preoperative assessment of U neutrophil gelatinase-associated lipocalin (NGAL) and liver-type fatty acid-binding protein (L-FABP) predicted the need for KRT with 75% accuracy. The combined assessment of U osmolality (OSM), U kidney injury molecule 1 (KIM-1), and tissue inhibitor of metalloproteinase (TIMP-1) within 48 h post-LT predicted severe AKI with 80% accuracy. U-OSM alone, measured within 48 h post-LT, had an accuracy of 83% for predicting KRT need, outperforming any BM combination.
Combined BM analysis can accurately predict severe AKI and KRT needs in the perioperative period of LT. U-OSM alone proved to be an effective tool for monitoring the risk of severe AKI, available in most centers. Further studies are needed to assess its impact on AKI progression postoperatively.Registered at Clinical Trials (clinicaltrials.gov) in March 24th, 2014 by title 'Acute Kidney Injury Biomarkers: Diagnosis and Application in Pre-operative Period of Liver Transplantation (AKIB)' and identifier NCT02095431.
肾功能障碍是肝移植（LT）后常见的并发症。本研究旨在确定在 LT 后 48 小时内使用 19 种血清和尿液生物标志物（BMs）全面评估肾功能是否可以提高对严重急性肾损伤（AKI）的预测能力，并在术后第一周内预测是否需要肾脏替代治疗（KRT）。
在术前和术后期间采集血液和尿液（U）样本。在 LT 后 48 小时内评估 19 种 BMs，以评估肾脏健康状况。分类回归树（CART）交叉验证确定关键预测因子，以确定预测结果的最佳 BM 组合。
在 100 例 LT 患者中，36 例发生严重 AKI，34 例在术后第一周内需要 KRT。U 中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和肝型脂肪酸结合蛋白（L-FABP）的术前评估可预测 KRT 的需求，准确率为 75%。LT 后 48 小时内 U 渗透压（OSM）、U 肾损伤分子 1（KIM-1）和组织金属蛋白酶抑制剂（TIMP-1）联合评估对严重 AKI 的预测准确率为 80%。LT 后 48 小时内单独测量的 U-OSM 对预测 KRT 需求的准确性为 83%，优于任何 BM 组合。
联合 BMs 分析可准确预测 LT 围手术期严重 AKI 和 KRT 的需求。LT 后 48 小时内单独使用 U-OSM 已被证明是一种有效的监测严重 AKI 风险的工具，在大多数中心都可以获得。需要进一步的研究来评估其对术后 AKI 进展的影响。于 2014 年 3 月 24 日在 ClinicalTrials.gov 上以“急性肾损伤生物标志物：肝移植术前诊断和应用（AKIB）”为题注册，并标识符为 NCT02095431。
