Urinary-Neutrophil Gelatinase-Associated Lipocalin (u-NGAL) as a predictor of Acute Kidney Injury in post-liver transplant recipients (Article)

Objective

The aim of this work is to study the value of u-NGAL as an early predictor for occurrence of AKI in patients undergoing liver transplantation (LT) in comparison with SCr and RIFLE classification.

Background

Renal dysfunction is common after LT. The incidence of AKI complicating the post transplant period varies between 48% and 94% and affects both short-term and long-term outcome. The difficulties in early intervention contribute significantly to the poor prognosis of AK.

Materials and methods

This study was carried on 30 hepatic patients underwent LT in the National Liver Institute, Menoufia University, Egypt, in the period from June 2012 to May 2014, thorough history taking, clinical examination and preoperative routine investigations, and baseline renal functions including assessment of GFR by renal scan were done. Operative data were collected during LT, patient were also assessed 5 days postoperatively for the occurrence of AKI by SCr, urine output and RIFLE classification vs u-NGAL.

Results

14/30 patients (46.7%) had fulfilled the criteria of RIFLE classification and had AKI, in those patients there was a significant relation between RIFLE classification and the cause of LT, preoperative platelet count, the use of basiliximab in the induction of immunosuppression and day1, day2  u-NGAL.

While u-NGAL levels above the cut-off value of 1300 pg/ml at day1 and 4440 pg/ml at day2 are considered good predictors of AKI post-LT with AUROC 0.77 and 0.77 respectively, with accepted accuracy 66.7 % and 73.3%, and high sensitivity, specificity for prediction of AKI post-LT, and correlate significantly with different preop. and operative parameters.

Conclusion

u-NGAL is a valuable marker for early detection of AKI in patients undergoing LT before rise of SCr. levels above the cut-off value (1300 pg/ml) have a high sensitivity, specificity and positive predictive value for AKI post-LT.

Posted by: Mohamed Hamdy , Dr, menoufia University Hospital, Egypt (06-May-2015)
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