Neutrophil gelatinase-associated lipocalin in kidney and liver transplantation

Expanding the criteria for deceased organ donors increases the risk of delayed graft function (DGF) complicating kidney transplant outcome. Liver transplant recipients are at an increased risk for kidney injury both before and after transplantation and renal dysfunction strongly associates with morbidity and mortality. Identifying kidney injury early is crucial in achieving favorable outcome after transplantation. However, there are currently no reliable methods for predicting kidney damage in transplant patients. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel marker for acute kidney injury. The aim of the study was thus to test whether kidney donor and recipient urine and serum NGAL could predict DGF and prolonged DGF lasting >14 days, and whether plasma NGAL obtained prior to liver transplantation could predict prolonged kidney injury. The studies included 99 deceased kidney donors and their 176 adult recipients and 203 consecutive liver transplant recipients. DGF was seen in 39% of the kidney grafts and the duration of DGF was prolonged in 26 cases. Long-term graft function was significantly decreased in prolonged DGF grafts. NGAL correlated with other markers that describe kidney function such as serum creatinine and GFR. Based on the results measuring serum or urine NGAL the following morning after transplantation predicts DGF and prolonged DGF. Donor urine NGAL correlated with prolonged DGF. In the liver transplant recipients, pretransplant NGAL could not predict posttransplant kidney injury. However, it predicted irreversibility of pretransplant kidney dysfunction, which is helpful in optimizing patient care and deciding whether combined liver-kidney transplantation is needed. In conclusion, measuring blood (serum or plasma) NGAL is useful in assessing kidney function after kidney and liver transplantation.