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Maslauskiene R, Vaiciuniene R, Tretjakovs P, Gersone G, Radzeviciene A, Bura A, Stankevicius E, Bumblyte IA. Deceased Kidney Donor Biomarkers: Relationship between Delayed Kidney Function and Graft Function Three Years after Transplantation. Diagnostics (Basel) 2024; 14:717. [PMID: 38611630 PMCID: PMC11011901 DOI: 10.3390/diagnostics14070717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
With an increasing number of marginal donors, additional methods for the evaluation of cadaveric kidney quality are required. This study aimed to evaluate pretransplant deceased donor serum (s) and urine (u) biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin-18, and C-X-C motif chemokine 10 (CXCL10) for predicting early and late graft function. In total, 43 deceased kidney donors and 76 corresponding recipients were enrolled. Delayed graft function (DGF) occurred in 27.6% of cases. sIL-18, sKIM-1, uNGAL, and uKIM-1 were predictors of DGF. A model incorporating sIL-18, uKIM-1, and clinical factors was developed to predict DGF (AUROC 0.863). Univariate analysis showed a negative association between uKIM and graft eGFR at 6, 12, 24, and 36 months, but this was not confirmed in the multivariate analysis. In conclusion, we report a superior performance of donor biomarkers for predicting DGF and later graft function over serum creatinine. Higher levels of donor sIL-18 and uKIM in conjunction with expanded-criteria donors and longer cold ischemia times predicted DGF. With no renal tubular damage in zero-time donor biopsies, higher pretransplant urine and serum NGAL levels were associated with better allograft function one year after transplantation, and sNGAL with graft function three years after transplantation.
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Affiliation(s)
- Rima Maslauskiene
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (R.V.); (A.B.); (I.A.B.)
| | - Ruta Vaiciuniene
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (R.V.); (A.B.); (I.A.B.)
| | - Peteris Tretjakovs
- Department of Human Physiology and Biochemistry, Riga Stradins University, Dzirciema Str. 16, LV-1007 Riga, Latvia; (P.T.); (G.G.)
| | - Gita Gersone
- Department of Human Physiology and Biochemistry, Riga Stradins University, Dzirciema Str. 16, LV-1007 Riga, Latvia; (P.T.); (G.G.)
| | - Aurelija Radzeviciene
- Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus Str. 9, LT-44307 Kaunas, Lithuania; (A.R.); (E.S.)
| | - Andrejus Bura
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (R.V.); (A.B.); (I.A.B.)
| | - Edgaras Stankevicius
- Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus Str. 9, LT-44307 Kaunas, Lithuania; (A.R.); (E.S.)
| | - Inga Arune Bumblyte
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (R.V.); (A.B.); (I.A.B.)
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Urinary Biomarkers in a Living Donor Kidney Transplantation Cohort—Predictive Value on Graft Function. Int J Mol Sci 2023; 24:ijms24065649. [PMID: 36982720 PMCID: PMC10054503 DOI: 10.3390/ijms24065649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Early non-invasive detection and prediction of graft function after kidney transplantation is essential since interventions might prevent further deterioration. The aim of this study was to analyze the dynamics and predictive value of four urinary biomarkers: kidney injury molecule-1 (KIM-1), heart-type fatty acid binding protein (H-FABP), N-acetyl-β-D-glucosaminidase (NAG), and neutrophil gelatinase-associated lipocalin (NGAL) in a living donor kidney transplantation (LDKT) cohort. Biomarkers were measured up to 9 days after the transplantation of 57 recipients participating in the VAPOR-1 trial. Dynamics of KIM-1, NAG, NGAL, and H-FABP significantly changed over the course of 9 days after transplantation. KIM-1 at day 1 and NAG at day 2 after transplantation were significant predictors for the estimated glomerular filtration rate (eGFR) at various timepoints after transplantation with a positive estimate (p < 0.05), whereas NGAL and NAG at day 1 after transplantation were negative significant predictors (p < 0.05). Multivariable analysis models for eGFR outcome improved after the addition of these biomarker levels. Several donor, recipient and transplantation factors significantly affected the baseline of urinary biomarkers. In conclusion, urinary biomarkers are of added value for the prediction of graft outcome, but influencing factors such as the timing of measurement and transplantation factors need to be considered.
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Aldea PL, Rachisan AL, Stanciu BI, Picos A, Picos AM, Delean DI, Stroescu R, Starcea MI, Borzan CM, Elec FI. The Perspectives of Biomarkers in Predicting the Survival of the Renal Graft. Front Pediatr 2022; 10:869628. [PMID: 35722493 PMCID: PMC9204089 DOI: 10.3389/fped.2022.869628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Kidney transplantation (KT) is currently the elective approach for patients with end-stage renal disease. Although it is a safe choice for these patients, the early complications can lead to graft dysfunction. One of the most redoubtable complications is delayed graft function (DGF), having no specific treatment. The effects of DGF on the graft survival are large enough to justify the formulation of specific biological protocols. Therefore, discovering biomarkers of acute impairment in renal transplanted patients is required. Creatinine is a poor marker to establish the kidney injury. Estimated glomerular filtration rate together with creatinine is ready to approximately measure the kidney function. Different serum and urine proteins are being studied as possible predictive biomarkers for delayed graft function. This review will concentrate on recent and existing research which provide insight concerning the contribution of some molecules for the estimation and evaluation of graft function after kidney transplantation. Further studies examining various aspects of DGF after KT are urgently needed to address a hitherto less-known clinical question.
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Affiliation(s)
- Paul Luchian Aldea
- Department of Community Medicine, Discipline of Public Health and Management, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreea Liana Rachisan
- Department of Mother and Child, Discipline of Pediatrics II, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bogdan Ioan Stanciu
- Department of Radiology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Picos
- Department of Prevention in Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alina Monica Picos
- Department of Dental Prosthetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Ioan Delean
- Department of Mother and Child, Discipline of Pediatrics II, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ramona Stroescu
- Department of Pediatrics, Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Cristina Maria Borzan
- Department of Community Medicine, Discipline of Public Health and Management, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Florin Ioan Elec
- Department of Surgical Sciences, Discipline of Urology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Passov A, Ilmakunnas M, Pihlajoki M, Hermunen K, Lempinen M, Helanterä I, Kailari V, Heikinheimo M, Andersson S, Pesonen E. Neutrophil gelatinase-associated lipocalin does not originate from the kidney during reperfusion in clinical renal transplantation. Intensive Care Med Exp 2021; 9:56. [PMID: 34807337 PMCID: PMC8608972 DOI: 10.1186/s40635-021-00422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 11/11/2021] [Indexed: 11/12/2022] Open
Abstract
Background Acute Kidney Injury (AKI) is a common clinical complication. Plasma/serum neutrophil gelatinase-associated lipocalin (NGAL) has been proposed as a rapid marker of AKI. However, NGAL is not kidney-specific. It exists in three isoforms (monomeric, homo-dimeric and hetero-dimeric). Only the monomeric isoform is produced by renal tubular cells and plasma NGAL levels are confounded by the release of all NGAL isoforms from neutrophils. Our aim was to investigate whether NGAL is released into blood from injured renal tubules. Methods Kidney transplantation (n = 28) served as a clinical model of renal ischaemic injury. We used ELISA to measure NGAL concentrations at 2 minutes after kidney graft reperfusion in simultaneously taken samples of renal arterial and renal venous blood. Trans-renal gradients (venous–arterial) of NGAL were calculated. We performed Western blotting to distinguish between renal and non-renal NGAL isoforms. Liver-type fatty acid binding protein (LFABP) and heart-type fatty acid binding protein (HFABP) served as positive controls of proximal and distal tubular damage. Results Significant renal release of LFABP [trans-renal gradient 8.4 (1.7–30.0) ng/ml, p = 0.005] and HFABP [trans-renal gradient 3.7 (1.1–5.0) ng/ml, p = 0.003] at 2 minutes after renal graft reperfusion indicated proximal and distal tubular damage. NGAL concentrations were comparable in renal venous and renal arterial blood. Thus, there was no trans-renal gradient of NGAL. Western blotting revealed that the renal NGAL isoform represented only 6% of the total NGAL in renal venous blood. Conclusions Ischaemic proximal and distal tubular damage occurs in kidney transplantation without concomitant NGAL washout from the kidney graft into blood. Plasma/serum NGAL levels are confounded by the release of NGAL from neutrophils. Present results do not support the interpretation that increase in plasma NGAL is caused by release from the renal tubules.
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Affiliation(s)
- Arie Passov
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PO BOX 266, 00029 HUS, Helsinki, Finland.
| | - Minna Ilmakunnas
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Marjut Pihlajoki
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland
| | - Kethe Hermunen
- Transplantation and Liver Surgery Clinic, Abdominal Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Marko Lempinen
- Transplantation and Liver Surgery Clinic, Abdominal Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Ilkka Helanterä
- Transplantation and Liver Surgery Clinic, Abdominal Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Villemikko Kailari
- Faculty of Medicine, University of Helsinki, PO BOX 63, 00014, Helsinki, Finland
| | - Markku Heikinheimo
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland.,Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, St. Louis, MO, 63110, USA
| | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland
| | - Eero Pesonen
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
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Lai C, Yee SY, Ying T, Chadban S. Biomarkers as diagnostic tests for delayed graft function in kidney transplantation. Transpl Int 2021; 34:2431-2441. [PMID: 34626503 DOI: 10.1111/tri.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/29/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
Delayed graft function (DGF) after kidney transplantation is associated with inferior outcomes and higher healthcare costs. DGF is currently defined as the requirement for dialysis within seven days post-transplant; however, this definition is subjective and nonspecific. Novel biomarkers have potential to improve objectivity and enable earlier diagnosis of DGF. We reviewed the literature to describe the range of novel biomarkers previously studied to predict DGF. We identified marked heterogeneity and low reporting quality of published studies. Among the novel biomarkers, serum NGAL had the greatest potential as a biomarker to predict DGF, but requires further assessment and validation through larger scale studies of diagnostic test performance. Given inadequacies in the dialysis-based definition, coupled with the high incidence and impact of DGF, such studies should be pursued.
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Affiliation(s)
- Christina Lai
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Seow Yeing Yee
- Nephrology Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Tracey Ying
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Steve Chadban
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Modarresi A, Nafar M, Sahraei Z, Salamzadeh J, Ziaie S. Early Graft Function in Deceased Donor Renal Recipients: Role of N-Acetylcysteine. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2020; 19:57-67. [PMID: 32922469 PMCID: PMC7462497 DOI: 10.22037/ijpr.2019.15546.13167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Reduced graft function (RGF) in donor renal transplant recipients is caused by oxidative damage due to extensive ischemia-reperfusion (I/R) injury during transplantation. Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker to detect tubular injury early after renal transplantation. N-acetylcysteine (NAC) is a potent antioxidant that can reduce I/R injury by improving oxidative damage. The aim of the present study is to assess the efficacy of NAC in improving graft function and reducing renal tubular injury in deceased donor renal transplant recipients. A double-blind, randomized clinical trial was conducted on 50 deceased donor renal transplant recipients. The patients were randomized into two groups, receiving either 600 mg NAC twice daily, or placebo (days 0 to 5). Results were assessed based on the rate of RGF, levels of plasma NGAL (p-NGAL) and the estimated glomerular filtration rate (eGFR). The rate of RGF was significantly lower in the patients receiving NAC vs. placebo (21.4% vs. 50%). The measurement of p-NGAL levels showed that the patients in the NAC group had significantly greater reduction of p-NGAL by both days 1 and 5 post-transplantation than those in the placebo group. A near steady-state eGFR level was reached by week 1 in the NAC group, however, the improvement of eGFR was significantly slower in the placebo group and a near steady-state was only achieved by week 4. NAC has promising potential in reducing tubular injury and improving graft function, evidenced by significant reduction in the rate of RGF and levels of p-NGAL.
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Affiliation(s)
- Atieh Modarresi
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.,Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Nafar
- Chronic Kidney Disease Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Sahraei
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamshid Salamzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Ziaie
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Li YM, Li Y, Yan L, Wang H, Wu XJ, Tang JT, Wang LL, Shi YY. Comparison of urine and blood NGAL for early prediction of delayed graft function in adult kidney transplant recipients: a meta-analysis of observational studies. BMC Nephrol 2019; 20:291. [PMID: 31375084 PMCID: PMC6679493 DOI: 10.1186/s12882-019-1491-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 07/25/2019] [Indexed: 02/05/2023] Open
Abstract
Background Neutrophil gelatinase-assoicated lipocalin (NGAL) appears to be a promising proximal tubular injury biomarker for early prediction of delayed graft function (DGF) in kidney transplant recipients. However, its predictive values in urine and blood were varied among different studies. Here, we performed the meta-analysis to compare the predictive values of urine NGAL (uNGAL) and blood NGAL (bNGAL) for DGF in adult kidney transplant recipients. Methods We systematically searched Medline, Cochrane library and Embase for relevant studies from inception to May 2018. The summary receiver operating characteristic (SROC) curves, the pooled sensitivity, specificity and diagnostic odds ratio (DOR) were used to evaluate the prognostic performance of uNGAL and bNGAL for the identification of DGF. Results A total of 1036 patients from 14 eligible studies were included in the analysis. 8 studies focused on NGAL in urine and 6 reported NGAL in serum or plasma. The composite area under the ROC (AUC) for 24 h uNGAL was 0.91 (95% CI, 0.89–0.94) and the overall DOR for 24 h uNGAL was 24.17(95% CI, 9.94–58.75) with a sensitivity of 0.88 (95% CI, 0.75–0.94) and a specificity of 0.81 (95% CI, 0.68–0.89). The composite AUC for 24 h bNGAL was 0.95 (95% CI, 0.93–0.97) and the overall DOR for 24 h bNGAL was 43.11 (95% CI, 16.43–113.12) with a sensitivity of 0.91 (95% CI, 0.81–0.96) and a specificity of 0.86 (95% CI, 0.78–0.92). Conclusions Urine and serum/plasma NGAL were valuable biomarkers for early identification of DGF in kidney transplantation. In addition, the bNGAL was superior to uNGAL in early prediction of DGF. Electronic supplementary material The online version of this article (10.1186/s12882-019-1491-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ya Mei Li
- Department of Laboratory Medicine/Research Centre of Clinical Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Li
- Department of Laboratory Medicine/Research Centre of Clinical Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Yan
- Department of Laboratory Medicine/Research Centre of Clinical Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Han Wang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Juan Wu
- Department of Laboratory Medicine/Research Centre of Clinical Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Tao Tang
- Department of Laboratory Medicine/Research Centre of Clinical Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lan Lan Wang
- Department of Laboratory Medicine/Research Centre of Clinical Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Yun Ying Shi
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China.
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Quintella AHDS, Lasmar MF, Fabreti-Oliveira RA, Nascimento E. Delayed Graft Function, Predictive Factors, and 7-Year Outcome of Deceased Donor Kidney Transplant Recipients With Different Immunologic Profiles. Transplant Proc 2018; 50:737-742. [PMID: 29661426 DOI: 10.1016/j.transproceed.2018.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Delayed graft function (DGF) is the major post-transplant cause of deleterious effects to the allograft and is associated with poor allograft survival. The aim of this study was to report the outcomes of 236 kidney transplant recipients with different immunologic profiles. METHODS All patients underwent transplantation (2008-2016) with a deceased donor at the University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil. Patients were classified into 3 groups according to immunologic profiles: nonsensitized (NS), sensitized without donor-specific antibody (SDSA-), or sensitized with donor-specific antibody (SDSA+). RESULTS DGF was observed in 128 (54.24%), including 63 (49.22%) NS, 51 (39.84%) SDSA-, and 14 (10.94%) SDSA+ patients. The development of DGF was associated with dialysis for ≥49.25 months (odds ratio [OR] 2.30), donor age ≥42.25 years (OR 1.77), donor end creatinine level >1.22 mg/dL (OR 1.94), and cold ischemia time >12 hours (OR 2.45). Of the 55 patients with rejections, 37 (15.68%) had T-cell-mediated rejection (TCMR) and 18 (7.63%) had antibody-mediated rejection (AMR). Nine patients (16.36%) exhibited graft loss, 2 (0.85%) via TCMR in the SDSA- DGF+ group and 7 (2.97%) via AMR, including 2 NS DGF-, 2 SDSA- DGF-, 1 SDSA- DGF+, and 2 SDSA+ DGF+ patients. Graft survival significantly differed between the NSDGF- and SDSA- DGF+ groups (P = .014) and between the NS DGF- and SDSA+ DGF- groups (P = .036). CONCLUSION In the 7-year period following transplantation, TCMR was more prevalent than AMR among patients with DGF. Graft loss was less prevalent among patients with TCMR than among those with AMR.
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Affiliation(s)
- A H D S Quintella
- University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil; Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil
| | - M F Lasmar
- University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil; Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil
| | - R A Fabreti-Oliveira
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB-Histocompatibility Laboratory, Belo Horizonte, Minas Gerais, Brazil
| | - E Nascimento
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB-Histocompatibility Laboratory, Belo Horizonte, Minas Gerais, Brazil.
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Selby PJ, Banks RE, Gregory W, Hewison J, Rosenberg W, Altman DG, Deeks JJ, McCabe C, Parkes J, Sturgeon C, Thompson D, Twiddy M, Bestall J, Bedlington J, Hale T, Dinnes J, Jones M, Lewington A, Messenger MP, Napp V, Sitch A, Tanwar S, Vasudev NS, Baxter P, Bell S, Cairns DA, Calder N, Corrigan N, Del Galdo F, Heudtlass P, Hornigold N, Hulme C, Hutchinson M, Lippiatt C, Livingstone T, Longo R, Potton M, Roberts S, Sim S, Trainor S, Welberry Smith M, Neuberger J, Thorburn D, Richardson P, Christie J, Sheerin N, McKane W, Gibbs P, Edwards A, Soomro N, Adeyoju A, Stewart GD, Hrouda D. Methods for the evaluation of biomarkers in patients with kidney and liver diseases: multicentre research programme including ELUCIDATE RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BackgroundProtein biomarkers with associations with the activity and outcomes of diseases are being identified by modern proteomic technologies. They may be simple, accessible, cheap and safe tests that can inform diagnosis, prognosis, treatment selection, monitoring of disease activity and therapy and may substitute for complex, invasive and expensive tests. However, their potential is not yet being realised.Design and methodsThe study consisted of three workstreams to create a framework for research: workstream 1, methodology – to define current practice and explore methodology innovations for biomarkers for monitoring disease; workstream 2, clinical translation – to create a framework of research practice, high-quality samples and related clinical data to evaluate the validity and clinical utility of protein biomarkers; and workstream 3, the ELF to Uncover Cirrhosis as an Indication for Diagnosis and Action for Treatable Event (ELUCIDATE) randomised controlled trial (RCT) – an exemplar RCT of an established test, the ADVIA Centaur® Enhanced Liver Fibrosis (ELF) test (Siemens Healthcare Diagnostics Ltd, Camberley, UK) [consisting of a panel of three markers – (1) serum hyaluronic acid, (2) amino-terminal propeptide of type III procollagen and (3) tissue inhibitor of metalloproteinase 1], for liver cirrhosis to determine its impact on diagnostic timing and the management of cirrhosis and the process of care and improving outcomes.ResultsThe methodology workstream evaluated the quality of recommendations for using prostate-specific antigen to monitor patients, systematically reviewed RCTs of monitoring strategies and reviewed the monitoring biomarker literature and how monitoring can have an impact on outcomes. Simulation studies were conducted to evaluate monitoring and improve the merits of health care. The monitoring biomarker literature is modest and robust conclusions are infrequent. We recommend improvements in research practice. Patients strongly endorsed the need for robust and conclusive research in this area. The clinical translation workstream focused on analytical and clinical validity. Cohorts were established for renal cell carcinoma (RCC) and renal transplantation (RT), with samples and patient data from multiple centres, as a rapid-access resource to evaluate the validity of biomarkers. Candidate biomarkers for RCC and RT were identified from the literature and their quality was evaluated and selected biomarkers were prioritised. The duration of follow-up was a limitation but biomarkers were identified that may be taken forward for clinical utility. In the third workstream, the ELUCIDATE trial registered 1303 patients and randomised 878 patients out of a target of 1000. The trial started late and recruited slowly initially but ultimately recruited with good statistical power to answer the key questions. ELF monitoring altered the patient process of care and may show benefits from the early introduction of interventions with further follow-up. The ELUCIDATE trial was an ‘exemplar’ trial that has demonstrated the challenges of evaluating biomarker strategies in ‘end-to-end’ RCTs and will inform future study designs.ConclusionsThe limitations in the programme were principally that, during the collection and curation of the cohorts of patients with RCC and RT, the pace of discovery of new biomarkers in commercial and non-commercial research was slower than anticipated and so conclusive evaluations using the cohorts are few; however, access to the cohorts will be sustained for future new biomarkers. The ELUCIDATE trial was slow to start and recruit to, with a late surge of recruitment, and so final conclusions about the impact of the ELF test on long-term outcomes await further follow-up. The findings from the three workstreams were used to synthesise a strategy and framework for future biomarker evaluations incorporating innovations in study design, health economics and health informatics.Trial registrationCurrent Controlled Trials ISRCTN74815110, UKCRN ID 9954 and UKCRN ID 11930.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter J Selby
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rosamonde E Banks
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Walter Gregory
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christopher McCabe
- Department of Emergency Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Julie Parkes
- Primary Care and Population Sciences Academic Unit, University of Southampton, Southampton, UK
| | | | | | - Maureen Twiddy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Janine Bestall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Tilly Hale
- LIVErNORTH Liver Patient Support, Newcastle upon Tyne, UK
| | - Jacqueline Dinnes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Marc Jones
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | | | - Vicky Napp
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sudeep Tanwar
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
| | - Naveen S Vasudev
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Baxter
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sue Bell
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David A Cairns
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - Neil Corrigan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter Heudtlass
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Nick Hornigold
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michelle Hutchinson
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Carys Lippiatt
- Department of Specialist Laboratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew Potton
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Stephanie Roberts
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sheryl Sim
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sebastian Trainor
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Matthew Welberry Smith
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Neuberger
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Paul Richardson
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - John Christie
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Neil Sheerin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - William McKane
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul Gibbs
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Naeem Soomro
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Grant D Stewart
- NHS Lothian, Edinburgh, UK
- Academic Urology Group, University of Cambridge, Cambridge, UK
| | - David Hrouda
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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10
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Modarresi A, Nafar M, Sahraei Z, Salamzadeh J, Chaibakhsh S, Ziaie S, Parvin M, Panahi Y, Einollahi B. N-acetylcysteine decreases urinary level of neutrophil gelatinase-associated lipocalin in deceased-donor renal transplant recipients: a randomized clinical trial. Biomarkers 2018; 23:589-596. [PMID: 29683755 DOI: 10.1080/1354750x.2018.1468823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
CONTEXT Acute kidney injury (AKI) is a common complication after kidney transplantation (KT), especially in recipients from deceased donors. Urinary neutrophil gelatinase-associated lipocalin (u-NGAL) is an early and sensitive marker of AKI after transplantation. OBJECTIVES We assessed the renoprotective effect of N-acetylcysteine (NAC) on u-NGAL levels as an early prognostic marker of graft function immediately after transplantation. MATERIALS AND METHODS A double-blind, randomized, placebo-controlled trial was conducted on 70 deceased-donor KT recipients ( www.irct.ir , trial registration number: IRCT2014090214693N4). Patients received 600 mg oral NAC or placebo twice daily from day 0 to 5 and urine samples were taken before, and on the first and fifth days after transplantation. U-NGAL and early graft function were compared between the two groups. RESULTS NAC significantly reduced u-NGAL levels compared to placebo (p value = 0.02), while improvement in early graft function with NAC did not reach statistical significance. CONCLUSIONS This study showed that NAC administration in deceased-donor KT recipients can reduce tubular kidney injury, evidenced by u-NGAL measurements. Improvement in early graft function needs a larger sample size to reach a statistical conclusion.
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Affiliation(s)
- Atieh Modarresi
- a Research Center for Rational Use of Drugs, Tehran University of Medical Sciences , Tehran , Iran
| | - Mohsen Nafar
- b Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Zahra Sahraei
- c Department of Clinical Pharmacy, School of Pharmacy , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Jamshid Salamzadeh
- c Department of Clinical Pharmacy, School of Pharmacy , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Samira Chaibakhsh
- a Research Center for Rational Use of Drugs, Tehran University of Medical Sciences , Tehran , Iran.,d Department of Biostatistics , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Shadi Ziaie
- c Department of Clinical Pharmacy, School of Pharmacy , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Mahmoud Parvin
- b Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Yunes Panahi
- e Pharmacotherapy Department, Faculty of Pharmacy, Baqiyatollah University of Medical Sciences , Tehran , Iran
| | - Behzad Einollahi
- f Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences , Tehran , Iran
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11
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van Londen M, Aarts BM, Sanders JSF, Hillebrands JL, Bakker SJL, Navis G, de Borst MH. Tubular maximum phosphate reabsorption capacity in living kidney donors is independently associated with one-year recipient GFR. Am J Physiol Renal Physiol 2018; 314:F196-F202. [PMID: 28978532 DOI: 10.1152/ajprenal.00287.2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The donor glomerular filtration rate (GFR) measured before kidney donation is a strong determinant of recipient graft outcome. No tubular function markers have been identified that can similarly be used in donors to predict recipient outcomes. In the present study we investigated whether the pre-donation tubular maximum reabsorption capacity of phosphate (TmP-GFR), which may be considered a functional tubular marker in healthy kidney donors, is associated with recipient GFR at 1 yr after transplantation, a key determinant of long-term outcome. We calculated the pre-donation TmP-GFR from serum and 24-h urine phosphate and creatinine levels in 165 kidney donors, and recipient 125I-iothalamate GFR and eGFR (CKD-EPI) at 12 mo after transplantation. Kidney donors were 51 ± 10 yr old, 47% were men, and mean GFR was 118 ± 26 ml/min. The donor TmP-GFR was associated with recipient GFR 12 mo after transplantation (GFR 6.0 ml/min lower per 1 mg/dl decrement of TmP-GFR), which persisted after multivariable adjustment for donor age, sex, pre-donation GFR, and blood pressure and other potential confounders. Results were highly similar when eGFR at 12 mo was taken as the outcome. Tubular damage markers kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin were low and not associated with recipient GFR. A lower donor TmP-GFR before donation, which may be considered to represent a functional measure of tubular phosphate reabsorption capacity, is independently associated with a lower recipient GFR 1 yr after transplantation. These data are the first to link donor tubular phosphate reabsorption with recipient GFR post-transplantation.
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Affiliation(s)
| | | | | | - Jan-Luuk Hillebrands
- Department of Medical Biology and Pathology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | | | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology
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12
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Maier HT, Ashraf MI, Denecke C, Weiss S, Augustin F, Messner F, Vallant N, Böcklein M, Margreiter C, Göbel G, Pratschke J, Öfner-Velano D, Aigner F. Prediction of delayed graft function and long-term graft survival by serum and urinary neutrophil gelatinase-associated lipocalin during the early postoperative phase after kidney transplantation. PLoS One 2018; 13:e0189932. [PMID: 29304176 PMCID: PMC5755755 DOI: 10.1371/journal.pone.0189932] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/05/2017] [Indexed: 11/18/2022] Open
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as an early marker protein for kidney dysfunction in various clinical settings. In this prospective study we evaluated serial changes of serum and urinary NGAL within the first 7 days after kidney transplantation in 170 consecutive recipients. The main focus of this study was to assess the performance of serum and urinary NGAL in the prediction of delayed graft function (DGF) and two-year graft and patient survival. Serum and urine samples of 170 patients undergoing primary kidney transplantation from October 2010 to December 2012 were prospectively collected from day 0 to 7. NGAL was analyzed by ELISA. Multivariate regression models, receiver-operating characteristics (ROC), and areas under ROC curves (AUC) were used to identify predictors of DGF. DGF occurred in 52 patients (30.6%). Serum (AUC = 0.869) and urinary NGAL (AUC = 0.872) on postoperative day (POD) 2 could accurately predict DGF compared to serum creatinine (AUC = 0.619). Multivariate analyses revealed donor age, serum and urinary NGAL significantly associated with DGF (p<0.001). Recipient age was the only significant factor in a cox regression model influencing two-year graft and patient survival. In conclusion, serum and urinary NGAL are early predictors of DGF after kidney transplantation.
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Affiliation(s)
- Herbert Thomas Maier
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Muhammad Imtiaz Ashraf
- Daniel-Swarovski-Research Laboratory, Innsbruck Medical University, Innsbruck, Austria
- Charité Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Berlin, Germany
| | - Christian Denecke
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
- Charité Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Berlin, Germany
| | - Sascha Weiss
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
- Charité Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Berlin, Germany
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Franka Messner
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Natalie Vallant
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Matthias Böcklein
- Daniel-Swarovski-Research Laboratory, Innsbruck Medical University, Innsbruck, Austria
| | - Christian Margreiter
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Georg Göbel
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Johann Pratschke
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
- Charité Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Berlin, Germany
| | - Dietmar Öfner-Velano
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Felix Aigner
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
- Charité Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Berlin, Germany
- * E-mail:
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13
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Chi J, Ma Y, Weng FL, Thiessen-Philbrook H, Parikh CR, Du H. Surface-enhanced Raman scattering analysis of urine from deceased donors as a prognostic tool for kidney transplant outcome. JOURNAL OF BIOPHOTONICS 2017; 10:1743-1755. [PMID: 28485029 PMCID: PMC5680137 DOI: 10.1002/jbio.201700019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/15/2017] [Accepted: 04/18/2017] [Indexed: 05/07/2023]
Abstract
We report the utility of surface-enhanced Raman scattering (SERS) analysis of urine from deceased donors for prognosis of kidney transplant outcomes. Iodide-modified silver nanoparticles were used as the enabler for sensitive measurements of urine proteins. Principal component analysis (PCA) and linear discriminant analysis (LDA) were employed for the statistical analysis of the SERS data. Thirty urine samples in three classes were analysed. The ATN class consists of donors whose kidneys had acute tubular necrosis (ATN), the most common type of acute kidney injury (AKI) with high risk of poor graft performance in recipients, yet yielded acceptable transplant outcome. The DGF class is comprised of donors whose kidney had delayed graft function (DGF) in recipients. The control class includes donors whose kidneys did not have donor ATN or recipient DGF. We show a sensitivity of more than 90 % in differentiating the ATN class from the DGF and control classes. Our methodology can thus help clinicians choose kidneys in the high-risk ATN category for transplant which would otherwise be discarded. Our research is impactful in that it could serve as a valuable guidance to expand the deceased donor pool to include those perceived as high-risk AKI type based on common urinary biomarkers. Picutre: Scheme of SERS analysis of urine samples from deceased donors for kidney transplant outcome indication.
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Affiliation(s)
- Jingmao Chi
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - Yiwei Ma
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - Francis L. Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ 07039, USA
| | | | - Chirag R. Parikh
- Department of Medicine, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Henry Du
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, NJ 07030, USA
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14
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A rapid and highly sensitive immunoassay format for human lipocalin-2 using multiwalled carbon nanotubes. Biosens Bioelectron 2017; 93:198-204. [DOI: 10.1016/j.bios.2016.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/25/2022]
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15
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Zununi Vahed S, Omidi Y, Ardalan M, Samadi N. Dysregulation of urinary miR-21 and miR-200b associated with interstitial fibrosis and tubular atrophy (IFTA) in renal transplant recipients. Clin Biochem 2017; 50:32-39. [DOI: 10.1016/j.clinbiochem.2016.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/26/2016] [Accepted: 08/06/2016] [Indexed: 02/07/2023]
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16
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Nashan B, Abbud-Filho M, Citterio F. Prediction, prevention, and management of delayed graft function: where are we now? Clin Transplant 2016; 30:1198-1208. [PMID: 27543840 DOI: 10.1111/ctr.12832] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 12/28/2022]
Abstract
Delayed graft function (DGF) remains a major barrier to improved outcomes after kidney transplantation. High-risk transplant recipients can be identified, but no definitive prediction model exists. Novel biomarkers to predict DGF in the first hours post-transplant, such as neutrophil gelatinase-associated lipocalin (NGAL), are under investigation. Donor management to minimize the profound physiological consequences of brain death is highly complex. A hormonal resuscitation package to manage the catecholamine "storm" that follows brain death is recommended. Donor pretreatment with dopamine prior to procurement lowers the rate of DGF. Hypothermic machine perfusion may offer a significant reduction in the rate of DGF vs simple cold storage, but costs need to be evaluated. Surgically, reducing warm ischemia time may be advantageous. Research into recipient preconditioning options has so far not generated clinically helpful interventions. Diagnostic criteria for DGF vary, but requirement for dialysis and/or persistent high serum creatinine is likely to remain key to diagnosis until current work on early biomarkers has progressed further. Management centers on close monitoring of graft (non)function and physiological parameters. With so many unanswered questions, substantial reductions in the toll of DGF in the near future seem unlikely but concentrated research on many levels offers long-term promise.
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Affiliation(s)
- Björn Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Mario Abbud-Filho
- Department of Nephrology, Medical School FAMERP, Director Organ Transplantation Center Foundation FUNFARME, São José do Rio Preto, SP, Brazil
| | - Franco Citterio
- Department of Surgery, Renal Transplantation, Catholic University, Rome, Italy
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17
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Lacquaniti A, Caccamo C, Salis P, Chirico V, Buemi A, Cernaro V, Noto A, Pettinato G, Santoro D, Bertani T, Buemi M, David A. Delayed graft function and chronic allograft nephropathy: diagnostic and prognostic role of neutrophil gelatinase-associated lipocalin. Biomarkers 2016; 21:371-8. [PMID: 26900638 DOI: 10.3109/1354750x.2016.1141991] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Available markers are not reliable parameters to early detect kidney injury in transplanted patients. OBJECTIVE Examine neutrophil gelatinase associated lipocalin (NGAL) in early detection of delayed graft function (DGF) and as a long-term predictor of graft outcome. PATIENTS AND METHODS NGAL was evaluated in 124 transplanted patients. RESULTS Urinary NGAL levels were associated to a 10% (HR: 1.10; 95% CI: 1.04-1.25; p < 0.001) and 15% (HR: 1.15; 95% CI: 1.09-1.26; p < 0.001) increased risk of DGF and allograft nephropathy progression, respectively. CONCLUSION NGAL reflects the entity of renal impairment in transplanted patients, representing a biomarker and an independent risk factor for DGF and chronic allograft nephropathy progression.
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Affiliation(s)
- Antonio Lacquaniti
- a Department of Internal Medicine , University Hospital of Messina , Messina , Italy
| | - Chiara Caccamo
- b Department of Internal Medicine , Mediterranean Institute for Transplantation and Advanced Specialized Therapies, ISMETT, University of Pittsburgh Medical Center , Palermo , Italy
| | - Paola Salis
- b Department of Internal Medicine , Mediterranean Institute for Transplantation and Advanced Specialized Therapies, ISMETT, University of Pittsburgh Medical Center , Palermo , Italy
| | - Valeria Chirico
- c Department of Pediatric Science , University Hospital of Messina , Messina , Italy
| | - Antoine Buemi
- d Surgery and Abdominal Transplantation Division, Cliniques Universitaires Saint-Luc, Université Catholique De Louvain , Brussels , Belgium , and
| | - Valeria Cernaro
- a Department of Internal Medicine , University Hospital of Messina , Messina , Italy
| | - Alberto Noto
- e Department of Neuroscience , University Hospital of Messina , Messina , Italy
| | - Giuseppina Pettinato
- a Department of Internal Medicine , University Hospital of Messina , Messina , Italy
| | - Domenico Santoro
- a Department of Internal Medicine , University Hospital of Messina , Messina , Italy
| | - Tullio Bertani
- a Department of Internal Medicine , University Hospital of Messina , Messina , Italy
| | - Michele Buemi
- a Department of Internal Medicine , University Hospital of Messina , Messina , Italy
| | - Antonio David
- e Department of Neuroscience , University Hospital of Messina , Messina , Italy
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18
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A triple-biomarker approach for the detection of delayed graft function after kidney transplantation using serum creatinine, cystatin C, and malondialdehyde. Clin Biochem 2015; 48:1033-8. [DOI: 10.1016/j.clinbiochem.2015.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/01/2015] [Accepted: 07/06/2015] [Indexed: 12/28/2022]
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19
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van den Akker EK, Hesselink DA, Manintveld OC, IJzermans JNM, de Bruijn RWF, Dor FJMF. Neutrophil Gelatinase-Associated Lipocalin, but Not Kidney Injury Marker 1, Correlates with Duration of Delayed Graft Function. Eur Surg Res 2015; 55:319-327. [PMID: 26451602 DOI: 10.1159/000440718] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/31/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND No specific early biomarker is available to measure kidney injury after kidney transplantation (KT). Both neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury marker 1 (KIM-1) increase after oxidative injury. Their potential as early biomarkers was evaluated in this one-arm pilot study. MATERIALS AND METHODS Twenty consecutive KT patients receiving a kidney from a donation after circulatory death donor were included. Graft perfusate was collected, as well as serum samples before transplantation, at the end of surgery, and 1, 4, and 7 days after transplantation. NGAL and KIM-1 were measured using ELISA. Kidney function and delayed graft function (DGF) were monitored. RESULTS In this cohort, 85% of the KT patients developed DGF. Perfusate NGAL correlated with donor age (r2 = 0.094, p = 0.01) and serum creatinine (r2 = 0.243, p = 0.05). A cardiac cause of death was associated with higher NGAL in the perfusate (p = 0.03). Serum NGAL at day 1 was significantly higher in patients with DGF (730 ng/ml, range 490-1,655, vs. 417 ng/ml, range 232-481; p = 0.01). Serum NGAL levels at day 1, 4, and 7 correlated with the duration of DGF. KIM-1 was not detectable in the perfusate or in the serum until postoperative day 4 in 80% of patients. CONCLUSIONS NGAL in the perfusate correlates with known donor risk factors for DGF. For the first time, we describe that serum NGAL at day 1 can discriminate between DGF and immediate graft function. Also, serum NGAL levels at day 1, 4, and 7 correlate with the duration of DGF. No association with KIM-1 was found. These data suggest that NGAL may be used as an early biomarker to detect DGF and warrants further study.
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Affiliation(s)
- Eline Kristina van den Akker
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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20
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Malyszko J, Lukaszyk E, Glowinska I, Durlik M. Biomarkers of delayed graft function as a form of acute kidney injury in kidney transplantation. Sci Rep 2015; 5:11684. [PMID: 26175216 PMCID: PMC4502393 DOI: 10.1038/srep11684] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/12/2015] [Indexed: 12/17/2022] Open
Abstract
Renal transplantation ensures distinct advantages for patients with end-stage kidney disease. However, in some cases early complications can lead to allograft dysfunction and consequently graft loss. One of the most common early complications after kidney transplantation is delayed graft function (DGF). Unfortunately there is no effective treatment for DGF, however early diagnosis of DGF and therapeutic intervention (eg modification of immunosuppression) may improve outcome. Therefore, markers of acute kidney injury are required. Creatinine is a poor biomarker for kidney injury due principally to its inability to help diagnose early acute renal failure and complete inability to help differentiate among its various causes. Different urinary and serum proteins have been intensively investigated as possible biomarkers in this setting. There are promising candidate biomarkers with the ability to detect DGF. We focused on emerging biomarkers of DGF with NGAL is being the most studied followed by KIM-1, L-FABP, IL-18, and others. However, large randomized studies are needed to establish the value of new, promising biomarkers, in DGF diagnosis, prognosis and its cost-effectiveness.
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Affiliation(s)
- Jolanta Malyszko
- 2nd Department of Nephrology, Medical University, Bialystok, Poland
| | - Ewelina Lukaszyk
- 2nd Department of Nephrology, Medical University, Bialystok, Poland
| | - Irena Glowinska
- 2nd Department of Nephrology, Medical University, Bialystok, Poland
| | - Magdalena Durlik
- Department of Nephrology and Transplantation Medicine, Warsaw Medical University, Poland
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Ramirez-Sandoval JC, Herrington W, Morales-Buenrostro LE. Neutrophil gelatinase-associated lipocalin in kidney transplantation: A review. Transplant Rev (Orlando) 2015; 29:139-44. [PMID: 26071983 DOI: 10.1016/j.trre.2015.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/08/2015] [Accepted: 04/30/2015] [Indexed: 12/13/2022]
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is a protein expressed by kidney tubular cells in response to ischemia, but may also be an early indicator of immunological rejection, calcineurin inhibitor toxicity, obstructive nephropathy, subclinical tubulitis or infection. Although there is currently no evidence to support the routine serial measurement of blood or urinary NGAL to detect subclinical acute tubular injury, NGAL has the potential to provide useful information to those that care for kidney transplant recipients (KTRs). First, high urinary or serum NGAL concentrations shortly after transplantation are a predictor of delayed graft function and are associated with reduced graft function at one year. Secondly, among KTRs with previously stable graft function who then suffer acute graft dysfunction, a high urinary NGAL predicts graft loss at one year. If further refined, diagnostic tests based on NGAL levels may provide future useful clinical tools.
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Affiliation(s)
- Juan C Ramirez-Sandoval
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador, Zubirán, ZP 14000, Mexico City, Mexico
| | - William Herrington
- Oxford Kidney Unit, Oxford University Hospitals NHS Trust, Churchill Hospital, Headington, Oxford, OX3 7LJ, UK
| | - Luis E Morales-Buenrostro
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador, Zubirán, ZP 14000, Mexico City, Mexico.
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