La lipocalina asociada con la gelatinasa de neutrófilos como factor temprano de predicción de la función retardada del injerto renal

Abstract

<p><strong>Introducción.</strong> La función retardada del injerto renal se presenta en 20 a 50 % de los trasplantes renales.<br /><strong>Objetivo.</strong> Describir el comportamiento de la lipocalina urinaria asociada a la gelatinasa de neutrófilos en receptores de trasplante renal de donante fallecido y compararlo con el porcentaje de descenso de la creatinina sérica para detectar tempranamente la función retardada del injerto renal.<br /><strong>Materiales y métodos.</strong> Se evaluaron los niveles de lipocalina urinaria asociada a la gelatinasa de neutrófilos en una cohorte prospectiva 1, 12, 24 y 48 horas después del trasplante renal, y se compararon diariamente con los de la creatinina sérica hasta el quinto día del trasplante.<br /><strong>Resultados.</strong> Se incluyeron en el estudio 79 pacientes con trasplante renal de donante fallecido. La función retardada del injerto renal se presentó en 13 pacientes (16,5 %) y cinco de ellos (6,3 %) necesitaron diálisis en la primera semana. Los valores de lipocalina urinaria asociada a la gelatinasa de neutrófilos en todos los puntos de corte fueron mayores en los pacientes con función retardada del injerto renal (p=0,526, p=0,049, p=0,032 y p=0,001, respectivamente). Se estableció un valor de más de 120 ng/ml a las 48 horas como factor de predicción de la función retardada del injerto, con una sensibilidad de 75 % y una especificidad de 71 %; el valor de creatinina sérica que mejor discriminó la función retardada se presentó a las 48 horas (59,5 %), con una sensibilidad de 92 % y una especificidad de 83 %. En la regresión logística los únicos valores significativos para predecir la función retardada del injerto renal fueron los de la creatinina serica.<br /><strong>Conclusión.</strong> Los niveles de lipocalina urinaria asociada a la gelatinasa de neutrófilos a las 48 horas del trasplante renal predijeron la función retardada, incluida la necesidad de diálisis, pero no fueron superiores a los de la creatinina sérica para la detección temprana.</p>

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

“…In Table 1, we have summarized the main published studies performed in renal transplant recipients, where the predictivity of uNGAL and pNGAL in terms of cut‐off levels, sensitivity and specificity were available 34, 36, 38, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52.…”

Comparison of urine and blood NGAL for early prediction of delayed graft function in adult kidney transplant recipients: a meta-analysis of observational studies

“…Males represented 61.4% of the study population. 9 studies defined DGF as the requirement for dialysis within 7 days after transplantation, 4 studies [13, 17–19] combined the dialysis-based criterion and the failure of Scr to decrease or the graft histopathology criterion to define DGF and pezeshgi’s study [20] did not describe the detailed definition of DGF. No significant differences were observed between 8 uNGAL studies and 6 bNGAL studies in terms of DCD or ECD ratio, donor age, donor Scr and CIT ( P > 0.05).…”

Time of cold ischemia and delayed graft function in a cohort of renal transplant patients in a reference center

“…Graft survival was lower in the group of patients with CIT >19 hours, compared with those who had a CIT >19 hours. Among the hypotheses that could explain the differences found in our study, we consider that universal induction accompanied by effective immunosuppressive therapies (tacrolimus and mycophenolate) in the majority of patients allow to control the immunological dysfunction secondary to a prolonged CIT,[ 4 24 25 ] which in turn decreases the frequency of AR and renal graft loss. [ 1 2 ]…”

“…The main outcome was DGF, defined as a decrease in serum creatinine of <10% per day for three consecutive days, the need for dialysis in the first week of kidney transplantation, or a serum creatinine level >3 mg/dl at the fifth day of kidney transplantation. [ 4 11 ] Secondary outcomes evaluated included the presence of AR confirmed by kidney biopsy and graft loss during the first year after kidney transplantation.…”

“…[ 1 2 ] Delayed graft function (DGF) is among the known risk factors for renal graft loss,[ 1 2 ] a complication that occurs in up to 50% of patients of deceased donors. [ 3 4 5 6 ] Different risk factors have been associated with the risk of DGF, among them are the creatinine values of the donor and the cold ischemia time (CIT),[ 1 3 ] the latter defined as the period elapsed after the cessation of circulation, when perfusion begins with preservation solutions, until the beginning of the vascular anastomosis in the renal graft recipient. [ 7 8 ]…”