P-NGAL Day 1 predicts early but not one year graft function following deceased donor kidney transplantation - The CONTEXT study

Marie B Nielsen, Nicoline V Krogstrup, Gertrude J Nieuwenhuijs-Moeke, Mihai Oltean, Frank J M F Dor, Bente Jespersen, Henrik Birn, Marie B Nielsen, Nicoline V Krogstrup, Gertrude J Nieuwenhuijs-Moeke, Mihai Oltean, Frank J M F Dor, Bente Jespersen, Henrik Birn

Abstract

Background: Early markers to predict delayed kidney graft function (DGF) may support clinical management. We studied the ability of four biomarkers (neutrophil gelatinase associated lipocalin (NGAL), liver-type fatty acid-binding protein (L-FABP), cystatin C, and YKL-40) to predict DGF after deceased donor transplantation, and their association with early graft function and GFR at three and twelve months.

Methods: 225 deceased donor kidney transplant recipients were included. Biomarkers were measured using automated assays or ELISA. We calculated their ability to predict the need for dialysis post-transplant and correlated with the estimated time to a 50% reduction in plasma creatinine (tCr50), measured glomerular filtration rate (mGFR) and estimated GFR (eGFR).

Results: All biomarkers measured at Day 1, except urinary L-FABP, significantly correlated with tCr50 and mGFR at Day 5. Plasma NGAL at Day 1 and a timed urine output predicted DGF (AUC = 0.91 and AUC 0.98). Nil or only weak correlations were identified between early biomarker levels and mGFR or eGFR at three or twelve months.

Conclusion: High plasma NGAL at Day 1 predicts DGF and is associated with initial graft function, but may not prove better than P-creatinine or a timed urine output. Early biomarker levels do not correlate with one-year graft function.

Trial registration: ClinicalTrials.gov NCT01395719.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flowchart of inclusion and randomization.
Fig 1. Flowchart of inclusion and randomization.
Fig 2. Prediction of DGF.
Fig 2. Prediction of DGF.
ROC-analyses (AUC) showing the ability to predict DGF for the timed urine output until Day 1 (n = 138), P-NGAL level on Day 1 (n = 199), the change in P-creatinine levels from baseline to Day 1 (n = 194), and P-creatinine level on Day 1 (n = 195).
Fig 3. The correlation between P-NGAL levels…
Fig 3. The correlation between P-NGAL levels on Day 1 and 3 and early kidney graft function.
A: Correlation between P-NGAL measured on Day 1 (dots) or 3 (triangles) and mGFR at Day 5. B: Correlation between P-NGAL measured on Day 1 (dots) or 3 (triangles) and tCr50.

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