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17.
Transplantation ; 102(5): 809-815, 2018 05.
Article in English | MEDLINE | ID: mdl-29300232

ABSTRACT

BACKGROUND: Urinary neutrophil gelatinase-associated lipocalin (uNGAL)-associated acute kidney injury is common after liver transplantation (LT), but whether early acute kidney injury predicts chronic kidney disease (CKD) and mortality remains uncertain. METHODS: Adults with LT from 2008 to 2010 in a previously published prospective cohort evaluating serial uNGAL pre- and post-LT were retrospectively assessed to evaluate uNGAL as a predictor of long-term outcomes post-LT. The primary outcomes were post-LT CKD, defined as Modification of Diet in Renal Disease estimated glomerular filtration rate less than 60 mL/min per 1.73 m for 3 continuous months, and death. RESULTS: uNGAL at 24 hours postreperfusion was significantly higher among patients who developed CKD. Multivariable modeling for the development of CKD demonstrated that uNGAL at 24-hours postreperfusion, 24 hours post-LT renal function, initial calcineurin inhibitor, and age were independent predictors of the development of CKD at in this cohort with long-term follow-up post-LT. Further, this association was stronger in those with preserved pre-LT renal function, a population where renal outcomes are often difficult to predict. CONCLUSIONS: We propose that perioperative uNGAL may identify patients at risk for CKD and allow for targeted early implementation of renal-sparing strategies.


Subject(s)
Kidney/metabolism , Lipocalin-2/urine , Liver Transplantation/adverse effects , Renal Insufficiency, Chronic/etiology , Adult , Aged , Biomarkers/urine , Calcineurin Inhibitors/adverse effects , Female , Glomerular Filtration Rate , Humans , Immunosuppressive Agents/adverse effects , Kidney/physiopathology , Male , Middle Aged , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/urine , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
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