Neutrophil gelatinase-associated lipocalin associated with irreversibility of pre-liver transplant kidney dysfunction.

Kidney outcomes in early post-liver transplantation ( LT) are crucial for long-term prognosis, but difficult to predict. Among 203 adult LT patients, we studied the value of plasma neutrophil gelatinase-associated lipocalin ( NGAL) measured pre- LT for predicting acute kidney injury ( AKI), kidney-replacement therapy within three months, and kidney dysfunction at three months post- LT. Glomerular filtration rate ( GFR) was estimated by creatinine-based and cystatin C-based equations. Highest NGAL levels were among patients on pre- LT kidney-replacement therapy, whereas NGAL exceeded 200 μg/L in only three (2%) patients with pre- LT GFR >60 mL/min. Pre- LT NGAL >260 μg/L predicted GFR <60 mL/min at three months post- LT ( OR 17.8, 95% CI 2.1-153) independently of 19 other variables reflecting recipient characteristics, liver and kidney function, perioperative hemodynamic stress, and immunosuppression. Of 81 patients with pre- LT GFR <60 mL/min, 48% had GFR <60 mL/min at three months, and an NGAL level >260 μg/L predicted this outcome with 90% specificity and 46% sensitivity. NGAL failed to predict post- LT AKI or need for temporary kidney-replacement therapy. In conclusion, NGAL independently predicted irreversibility of pre-LT kidney dysfunction and could thus help in optimizing patient care and in the decision to perform combined liver-kidney transplantation. Pre- LT NGAL was not useful in patients with preserved pre- LT kidney function or in predicting post- LT AKI. [ABSTRACT FROM AUTHOR]