Urine neutrophil gelatinase-associated lipocalin is a marker of graft recovery after kidney transplantation
Urine neutrophil gelatinase-associated lipocalin is a marker of graft recovery after kidney transplantation
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DOI：
10.1038/ki.2010.351
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发表时间：
2011-01-01
影响因子：
19.6
通讯作者：
Salmela, Kaija T.
中科院分区：
文献类型：
--
作者：
Hollmen, Maria E.;Kyllonen, Lauri E.;Salmela, Kaija T.
移植肾功能延迟恢复（DGF），尤其是长期的DGF，使肾移植结果复杂化。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是一种急性肾损伤标志物;因此，我们测试了尿NGAL是否可以预测DGF，延长DGF（持续超过14天），或无DGF（非DGF）移植受者的肾功能质量。我们收集了176名接受死亡供体肾移植的受者在移植前和移植后不同天的尿液样本。共有70例移植有DGF，其中26例延长。发生DGF的患者与未发生DGF的患者相比，尿NGAL的下降明显较慢，使得第1天NGAL预测DGF（曲线下面积（AUC）0.75）和预测的DGF，在112例第1天尿量超过1 l的病例中有15例（AUC 0.70），在86例第1天肌酐下降超过50 μ mol/l的病例中有19例（AUC 0.74）。第1天的尿NGAL水平预测DGF延长（AUC 0.75），与DGF缩短（100%）相比，DGF延长（73%）的1年移植物存活率明显更差。在非DGF中，与低NGAL相比，高第3天NGAL（大于平均值）与3周时肾功能显著较差相关，但在3个月和1年时则无关。NGAL与DGF的长期功能无关。因此，第1天尿NGAL预测DGF，即使在早期临床上没有预期，重要的是，它预测了导致移植物存活率更差的延长的DGF。Kidney International（2011）79，89-98; doi：10.1038/ki.2010.351; 2010年9月22日在线发表
Delayed graft function (DGF), especially long-lasting DGF, complicates kidney transplant outcome. Neutrophil gelatinase-associated lipocalin (NGAL) is an acute kidney injury marker; therefore, we tested whether urine NGAL could predict DGF, prolonged DGF (lasting over 14 days), or the quality of kidney function in transplant recipients without DGF (non-DGF). We collected urine samples from 176 recipients transplanted with deceased donor kidneys before and various days after transplantation. A total of 70 transplantations had DGF, of which 26 were prolonged. Patients who developed DGF had a significantly slower decrease in urinary NGAL compared with those without DGF, such that day 1 NGAL predicted DGF (area under the curve (AUC) 0.75) and predicted DGF in 15 of 112 cases with day 1 urine output over 1 l (AUC 0.70) and in 19 of 86 cases with a day 1 decrease in creatinine over 50 mu mol/l (AUC 0.74). The urinary NGAL level on day 1 predicted prolonged DGF (AUC 0.75), which had significantly worse 1-year graft survival (73%), compared with shorter DGF (100%). In non-DGF, high day 3 NGAL (greater than the mean) was associated with significantly worse kidney function at 3 weeks compared with low NGAL, but not at 3 months and 1 year. NGAL did not correlate with long-term function in DGF. Hence, day 1 urinary NGAL predicted DGF even when it was not clinically expected early on, and importantly, it predicted prolonged DGF that led to worse graft survival. Kidney International (2011) 79, 89-98; doi: 10.1038/ki.2010.351; published online 22 September 2010