Serum Neutrophil Gelatinase Associated Lipocalin During the Early Postoperative Period Predicts the Recovery of Graft Function After Kidney Transplantation From Donors After Cardiac Death
Serum Neutrophil Gelatinase Associated Lipocalin During the Early Postoperative Period Predicts the Recovery of Graft Function After Kidney Transplantation From Donors After Cardiac Death
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DOI：
10.1016/j.juro.2012.01.033
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发表时间：
2012-06-01
影响因子：
6.6
通讯作者：
Hoshinaga, Kiyotaka
中科院分区：
文献类型：
--
作者：
Kusaka, Mamoru;Iwamatsu, Fumi;Hoshinaga, Kiyotaka
目的：从心脏性死亡后的供体中获得肾脏具有很大的潜力来扩大供体库。然而，它们尚未被充分利用，部分原因是移植物功能延迟的发生率很高。尽管尿中性粒细胞明胶酶相关脂质运载蛋白是肾移植后肾损伤的一种众所周知的早期生物标志物，但由于无法获得尿液样本，其在移植物功能延迟的病例中的作用有限。我们评估了血清中性粒细胞明胶酶相关脂质运载蛋白作为一种潜在的生物标志物，以预测移植肾的功能恢复供体心脏death.Materials和方法：concentive患者移植肾从一个生活相关（39），脑死亡（1）或心脏死亡后（27）捐赠者回顾性参加了这项研究。在肾移植前后连续收集血清样品。结果：平均血清中性粒细胞明胶酶相关脂质运载蛋白在移植前阶段明显升高。移植后迅速下降。下降的斜率与恢复期相关性良好。通过分析ROC曲线，我们确定了截断预测立即，缓慢或延迟的移植功能，需要血液透析超过1 week，具有较高的灵敏度和特异性。结论：这些数据表明，系列监测血清中性粒细胞明胶酶相关脂质运载蛋白可以让我们预测移植物的恢复和需要血液透析肾移植后，从供体心脏死亡。
Purpose: Kidneys procured from donors after cardiac death hold great potential to expand the donor pool. However, they have not yet been fully used, in part due to the high incidence of delayed graft function. Although urine neutrophil gelatinase-associated lipocalin is a well-known early biomarker for renal injury after kidney transplantation, its usefulness is limited in cases with delayed graft function because of the unavailability of a urine sample. We evaluated serum neutrophil gelatinase-associated lipocalin as a potential biomarker to predict the functional recovery of kidneys transplanted from donors after cardiac death.Materials and Methods: Consecutive patients transplanted with a kidney from a living related (39), brain dead (1) or post-cardiac death (27) donor were retrospectively enrolled in the study. Serum samples were collected serially before and after kidney transplantation. Serum neutrophil gelatinase-associated lipocalin was measured using the ARCHITECT (R) assay.Results: Average serum neutrophil gelatinase-associated lipocalin was markedly high during the pre transplantation period. It decreased rapidly after transplantation. The slope of the decrease correlated well with the recovery period. By analyzing ROC curves we determined cutoffs to predict immediate, slow or delayed graft function requiring hemodialysis for longer than 1 week with high sensitivity and specificity.Conclusions: These data suggest that serial monitoring of serum neutrophil gelatinase-associated lipocalin may allow us to predict graft recovery and the need for hemodialysis after kidney transplantation from a donor after cardiac death.