Serum Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Organ Recovery from Delayed Graft Function after Kidney Transplantation from Donors after Cardiac Death

Abstract

Because of a worldwide shortage of renal grafts, kidneys procured from donors after cardiac death (DCD) have recently become an important source of renal transplants. However, DCD kidneys often have complications with delayed graft function (DGF) and recipients require hemodialysis (HD) in the early period after kidney transplantation (KTx). This study evaluated serum NGAL as a potential specific parameter to predict early functional recovery of transplanted DCD kidneys. The average serum neutrophil gelatinase-associated lipocalin (NGAL) level in normal samples was 53 +/- 30 ng/ml, while that in patients with chronic renal failure requiring HD was markedly raised at 963 +/- 33 ng/ml. In patients undergoing a living-related KTx from a living donor (n=11), serum NGAL level decreased rapidly after KTx, and only in two cases, with serum NGAL levels over 400 ng/ml on postoperative day 1 (POD1), was HD required due to DGF. In contrast, all patients undergoing a KTx from a DCD (n=5) required HD due to DGF. Even in these cases, serum NGAL levels decreased rapidly several days after a KTx prior to the recovery of urine output and preceding the decrease in serum creatinine level. The pattern of decline in serum NGAL was biphasic, the decrease after the second peak indicating a functional recovery within the next several days. These data suggest that monitoring of serum NGAL levels may allow us to predict graft recovery and the need for HD after a KTx from a DCD.

Early Urinary Biomarkers of Warm and Cold Ischemic Injury in an Experimental Kidney Model

“…In the transplant setting, a small clinical study showed that the intensity of NGAL staining in renal biopsies 1 h after reperfusion correlated well with the cold ischemic time and requirement for dialysis [22]. Urinary levels of NGAL on the day of transplant have also been shown to significantly predict DGF [23] and graft recovery [24]. However, NGAL has not been previously investigated in the pig in this setting.…”

Biomarkers of Acute Kidney Injury in Different Clinical Settings: A Time to Change the Paradigm?

“…NGAL staining in early biopsies from patients receiving a cadaveric kidney was strongly correlated with peak postoperative serum creatinine, which occurred days later. In a recent study, Kusaka et al [88] suggested that monitoring of serum NGAL levels might allow for the prediction of graft recovery and the need for hemodialysis after a kidney transplantation from a donor after cardiac death. They observed a dramatic fall in serum NGAL on the first postoperative day after transplantation from a living related donor reaching normal range on the 10th postoperative day.…”

“…They observed a dramatic fall in serum NGAL on the first postoperative day after transplantation from a living related donor reaching normal range on the 10th postoperative day. All of the patients after cadaveric kidney transplantation (kidney procured after cardiac death) required hemodialysis for 5-22 days [88] . In the study of Schaub et al [89] the stable transplant with the subclinical tubulitis group had slightly higher levels of NGAL (p = 0.06) than the stable transplant with the normal tubular histology group with a substantial overlap.…”

Increase in Serum Amylase and Resistive Index After Kidney Transplant Are Biomarkers of Delayed Graft Function

“…Therefore, many efforts have been made to identify novel biomarkers that could accurately and sensitively reveal early renal damage after transplantation. Recently, additional molecules, including gelatinaseassociated lipocalin (8,9), kidney injury molecule 1 (10), and interleukin 18 have been investigated to discriminate renal lesions after transplant and to evaluate the prognosis and efficacy of the therapeutic regimen (11).…”