Cystatin C as a marker of renal function immediately after liver transplantation

✍ Scribed by Gianni Biancofiore; Laura Pucci; Elisabetta Cerutti; Giuseppe Penno; Ennia Pardini; Massimo Esposito; Lucia Bindi; Erika Pelati; Anna Romanelli; Stefano Triscornia; Maria P. Salvadorini; Chiara Stratta; Giacomo Lanfranco; Giovanni Pellegrini; Stefano Del Prato; Mauro Salizzoni; Franco Mosca; Franco Filipponi

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 251 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20657

✦ Synopsis

To verify whether cystatin C may be of some use as a renal function marker immediately after orthotopic liver transplantation (OLT), we compared serum cystatin C (S Cyst ), serum creatinine (S cr ), and creatinine clearance (C cr ) levels with the glomerular filtration rate (GFR). On postoperative days 1, 3, 5, and 7, S Cyst and S cr was measured in simultaneously drawn blood samples, whereas C cr was calculated using a complete 24-hour urine collection. The GFR was determined on the same days by means of iohexol plasma clearance (I-GFR). The correlation between 1/S Cyst and I-GFR was stronger than that of 1/S cr or C cr (P < 0.01). In the case of moderate reductions in I-GFR (80-60 mL/minute/1.73 m 2 ), S cr remained within the normal range, whereas the increase in S cyst was beyond its upper limit; for I-GFR reductions to lower levels (59-40 mL/minute/1.73 m 2 ), S cr increased slightly, whereas S cyst was twice its upper normal limit. When we isolated all of the I-GFR values on days 3, 5, and 7 that were >30% lower than that recorded on the first postoperative day, S Cyst (P < 0.0001) and S cr (P < 0.01) levels were increased, whereas C cr remained unchanged (P ‫؍‬ 0.09). Receiver operating characteristic (ROC) area-under-the-curve analysis showed that the diagnostic accuracy of S cyst was better than that of S cr and C cr . S cyst levels of 1.4, 1.7, and 2.2 mg/L respectively predicted I-GFR levels of 80, 60, and 40 mL/minute/1.73 m 2 . In conclusion, cystatin C is a reliable marker of renal function during the immediate post-OLT period, especially when the goal is to identify moderate changes in GFR.