Nagaraju Shankar Prasad, Swaminathan Shilna Muttickal, Bhattacharya Shruti, Attur Ravindra Prabhu, Rangaswamy Dharshan, Rao Indu Ramachandra, Shenoy Srinivas Vinayak, Bhojaraja Mohan Varadanayakanahalli
Department of Nephrology Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Oman Med J. 2024 May 30;39(3):e630. doi: 10.5001/omj.2024.71. eCollection 2024 May.
The existing biomarkers used to promptly identify graft dysfunction after kidney transplantation lack consistency. Neutrophil gelatinase-associated lipocalin (NGAL) appears to be a promising biomarker but its levels measured from serum and urine have demonstrated varying predictive values. Our study aimed to explore the potential of NGAL as a biomarker in predicting graft dysfunction in kidney transplant patients, including live and deceased donor recipients.
A single-centered observational cohort study with live and deceased kidney recipients as participants was conducted between 2018 and 2022 at a tertiary care hospital in Southern India. Serum creatinine levels were monitored daily; creatinine reduction on day two and day seven were calculated. The recipients were categorized based on graft recovery into three groups: delayed graft function (DGF), slow graft function (SGF), or immediate graft function (IGF). Analysis of serum and urine NGAL was conducted two hours after the transplant and their predictive values were evaluated by the area under the curves (AUC) method.
Of the 40 participants, 34 (85.0%) received their transplant from live-related donors, while six (15.0%) received kidneys from deceased donors. DGF occurred in four (10.0%) patients, SGF in 12 (30.0%), and 24 (60.0%) patients achieved IGF. Serum NGAL demonstrated higher sensitivity compared to urine NGAL. At a cut-off value of 678 ng/mL (AUC = 0.77), serum NGAL showed 90.0% sensitivity and 53.0% specificity. Urine NGAL had 70.0% sensitivity and 74.0% specificity at a cut-off value of 489 ng/mL (AUC = 0.72).
Kidney recipients in SGF and DGF categories had elevated levels of serum and urine NGAL compared to those without IGF. Although serum NGAL showed higher sensitivity than urine NGAL in predicting graft dysfunction, both markers lacked the specificity needed for accurate predictions.
用于快速识别肾移植后移植物功能障碍的现有生物标志物缺乏一致性。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）似乎是一种有前景的生物标志物，但其在血清和尿液中的水平显示出不同的预测价值。我们的研究旨在探讨NGAL作为预测肾移植患者（包括活体和尸体供体受者）移植物功能障碍的生物标志物的潜力。
2018年至2022年期间，在印度南部一家三级护理医院进行了一项以活体和尸体肾受者为参与者的单中心观察性队列研究。每天监测血清肌酐水平；计算第二天和第七天的肌酐降低情况。根据移植物恢复情况将受者分为三组：延迟移植物功能（DGF）、缓慢移植物功能（SGF）或即时移植物功能（IGF）。在移植后两小时对血清和尿液NGAL进行分析，并通过曲线下面积（AUC）法评估其预测价值。
40名参与者中，34名（85.0%）接受了来自活体亲属供体的移植，而6名（15.0%）接受了来自尸体供体的肾脏。4名（10.0%）患者发生DGF，12名（30.0%）患者发生SGF，24名（60.0%）患者实现IGF。血清NGAL显示出比尿液NGAL更高的敏感性。在临界值为678 ng/mL（AUC = 0.77）时，血清NGAL显示出90.0%的敏感性和53.0%的特异性。尿液NGAL在临界值为489 ng/mL（AUC = 0.72）时具有70.0%的敏感性和74.0%的特异性。
与没有IGF的患者相比，SGF和DGF类别的肾移植受者血清和尿液NGAL水平升高。虽然血清NGAL在预测移植物功能障碍方面显示出比尿液NGAL更高的敏感性，但这两种标志物都缺乏准确预测所需的特异性。
