NIV Congres

Introduction Acute kidney injury (AKI) after liver transplantation (LT) is an important and common complication. Because of the delayed rise of serum creatinine (SCr) concentrations novel biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), glutathione S-transferase (GST), kidney injury molecule-1 (KIM-1) are proposed to detect AKI.

Methods We enrolled 26 consecutive adult liver transplant patients without pre-existent kidney disease to evaluate the diagnostic value of NGAL, GST and KIM-1 for the development of AKI. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. Markers were measured at 4 time points after LT; immediately after admission to the intensive care unit (ICU) (T = 0) and 4, 8 and 24 hours thereafter (T = 4, T = 8, T = 24 respectively). NGAL was measured in both plasma and urine (pNGAL and uNGAL respectively) and 2 subsets of GST were measured in the urine (α-GST and pi-GST). Furthermore we evaluated plasma Cystatin C (pCyC) concentrations as an alternative measure for GFR.

Results 9 of the 26 patients developed AKI according to the AKIN criteria. pNGAL and uNGAL detected the presence of AKI at various time points with an optimal area under the curve (AUC) at T = 8 for pNGAL (0.86; p = 0.004) and an optimal AUC at T = 4 for uNGAL (0.80; p = 0.012). Both α-GST and pi-GST did not show a significant difference between the two groups. KIM-1 failed to detect AKI, but it rose significantly over time in both groups. pCyC could also differentiate between AKI and no-AKI at various time points with an optimal AUC at T = 8 of 0.85 (95% CI = 0.66 – 1.00; p= 0.005).

Conclusions These findings suggest that especially PNGAL and UNGAL are promising biomarkers for the early detection of renal injury in patients after LT. Furthermore pCyC could be used as an alternative measure for GFR since it performed slightly better in the discrimination of AKI compared to SCr in this study.