Urinary and Serum Biomarkers for Prediction of Acute Kidney Injury in Patients Undergoing Liver Transplantation

Abstract

Acute kidney injury (AKI) is a frequent and serious complication of orthotopic liver transplantation (OLT), with a significant impact on mortality, graft survival, and chronic kidney disease. Currently, the diagnosis of AKI is based on changes in serum creatinine, which is a late marker, usually rising when there is already significant damage to the renal parenchyma. During the last 2 decades, various biomarkers have been studied in many clinical situations, mostly after cardiac surgery, in drug-induced AKI, or in sepsis. The present article summarizes the data on those biomarkers that have been evaluated for the prediction of AKI in patients undergoing OLT.

Kidney Function After Liver Transplantation in a Single Center

“…Renal dysfunctions, both AKI and CKD, in liver graft recipients, are clearly associated with post-LT morbidity and mortality [ 35 ]. Of note, RD after LT is associated with prolonged hospitalization and significant increase in hospitalization costs and ICU readmissions, and was reported to be the major risk factor for cardiac events [ 14 ]. However, despite the previously reported widely increasing problem of more severely ill cirrhotic patients with more comorbidities, our results did not reflect this trend in respect to MELD score and RD.…”

“…The development of RD before and/or after liver grafting is complicated and multifactorial. However, currently available methods of assessing RD in the setting of liver cirrhosis are not sufficient or practical enough [ 14 ]. Thus, in clinical practice, serum creatinine (SCr) testing is widely available and inexpensive, although the limitations of SCr are well known.…”

Kidney Failure after Liver Transplantation

“…Transjugular biopsy seems to be the method of choice because it has fewer complications but should be performed by experienced physicians due to a higher rate of failures or uninformative samples than transcutaneous biopsy. One potential solution is to use biomarkers to indicate the cause of kidney failure (functional or organic) and determine the capacity for recovery [137,197]. However, these tools are not yet available in current practice and need to be supported by further studies.…”

“…This would allow an appropriate transplant protocol to be established for each patient (indication of liver-kidney transplant, immunosuppression and surgical mode) to prevent kidney dysfunction. Lastly, in the near future, the emergence of new biomarkers or a new algorithm of biomarkers will be very important to better characterize kidney dysfunction during liver cirrhosis [147,197]. This will help for diagnostic (organic or pre-renal dysfunction), prognostic and recovery potential after kidney injury and for the prediction of kidney function after liver transplant.…”

How to assess kidney function in oncology patients

“…To overcome these limitations, several urinary markers have been proposed, such as neutrophil gelatinase-associated lipocalin, proinflammatory cytokines (interleukin-6 and interleukin-8), kidney injury molecule-1, and cell cycle markers such as urinary tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7. [28][29][30] Currently no information is available on its use in oncological settings, although the direct production of neutrophil gelatinase-associated lipocalin in cancer could limit its use as a marker of tubular damage. Similarly, plasma uric acid might represent a convenient and simple measure of nephron function 31 ; however, again, this marker is also released during tumor lysis, making it ineffective to establish kidney function in oncological settings.…”