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Abstract

Objectives: To investigate the predictive value of urinary neutrophil gelatinase-associated lipocalin in the occurrence of delayed graft function after kidney transplant. Materials and Methods: In this prospective cohort study of 67 consecutive patients who received a living-related (40 patients [61%]) or deceased-donor kidney transplant (27 patients [39%]), urinary neutrophil gelatinase-associated lipocalin was determined in the first 100 mL perfusate of the donor kidney and in urine at 6 hours after transplant. Patients were followed (11 ± 7 mo) for changes in estimated glomerular filtration rate and delayed graft function. Results: The mean urinary neutrophil gelatinaseassociated lipocalin level at 6 hours after transplant was significantly higher after deceased-donor (781 ± 452 ng/mL) than living-donor transplant (229 ± 223 ng/mL; P ≤ 0.001). The decrease in estimated glomerular filtration rate from 6 to 12 months after transplant was positively correlated with the urinary neutrophil gelatinase-associated lipocalin levels in the perfusate in living-donor transplant. A significant correlation was noted between the occurrence of delayed graft function and the urinary neutrophil gelatinase-associated lipocalin level at 6 hours after living-donor transplant. In the deceased-donor group, the occurrence of delayed graft function was correlated with urinary neutrophil gelatinase-associated lipocalin levels in the perfusate. In deceased-donor kidney transplant, the mean urinary neutrophil gelatinase-associated lipocalin level in the perfusion fluid was significantly greater from donors who had terminal serum creatinine > 150 μmol/L, and urinary neutrophil gelatinase-associated lipocalin level at 6 hours after transplant was significantly greater in transplants with longer cold ischemia time and donors who had hypertension. Conclusions: Urinary neutrophil gelatinase-associated lipocalin levels in the donor kidney perfusate and 6 hours after transplant may be a useful predictor of delayed graft function and decreased graft function from 6 to 12 months after transplant.

Urinary Biomarkers in a Living Donor Kidney Transplantation Cohort—Predictive Value on Graft Function

“…In line with previous studies, NGAL was a negative predictor for outcome after transplantation outcome [ 16 , 36 , 37 , 38 ]. Release of NGAL by distal tubular epithelial cells increases the severity of kidney injury such as IRI associated with transplantation.…”

Prediction of delayed graft function and long-term graft survival by serum and urinary neutrophil gelatinase–associated lipocalin during the early postoperative phase after kidney transplantation

“…These findings let us speculate that NGAL is not only a marker of tubular damage but also a filtration marker, but this requires further investigation. NGAL was tracked in both serum and urine compared to several other studies describing only urinary NGAL expression [ 12 , 23 , 27 – 29 ]. In multivariate analyses we could show, that urinary NGAL as well as serum NGAL can significantly predict DGF on the second postoperative day but not creatinine.…”

Neutrophil Gelatinase‐Associated Lipocalin as a Biomarker of Allograft Function After Renal Transplantation: Evaluation of the Current Status and Future Insights

“…It has been reported that kidney epithelia express and excrete large quantities of NGAL into urine following acute injury, reaching up to 1000‐fold induction of NGAL mRNA and protein in the most severe cases 33. There is a large body of literature to indicate that uNGAL increases during the first posttransplant week in renal transplant recipients with DGF, especially in the very early urine samples collected within six h postsurgery 34, 35, 36. Thus, the main potential advantage arising from this finding is the possibility to identify and stratify patients according to their risk of dialysis need after transplant, prior to the diagnosis of DGF.…”