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Plasma NGAL levels in stable kidney transplant recipients and the risk of allograft loss

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Item Type:Article
Title:Plasma NGAL levels in stable kidney transplant recipients and the risk of allograft loss
Creators Name:Swolinsky, J.S. and Hinz, R.M. and Markus, C.E. and Singer, E. and Bachmann, F. and Halleck, F. and Kron, S. and Naik, M.G. and Schmidt, D. and Obermeier, M. and Gebert, P. and Rauch, G. and Kropf, S. and Haase, M. and Budde, K. and Eckardt, K.U. and Westhoff, T.H. and Schmidt-Ott, K.M.
Abstract:BACKGROUND: The object of this study was to investigate the utility of Neutrophil gelatinase-associated lipocalin (NGAL) and Calprotectin (CPT) to predict long-term graft survival in stable kidney transplant recipients (KTR). METHODS: 709 stable outpatient KTR were enrolled >2 months post-transplant. The utility of plasma and urinary NGAL (pNGAL, uNGAL) and plasma and urinary CPT at enrollment to predict death-censored graft loss (GL) was evaluated during a 58-month follow-up. RESULTS: Among biomarkers, pNGAL showed best predictive ability for graft loss and was the only biomarker with an AUC > 0.7 for GL within 5 years. Patients with GL within 5 years (n=49) had a median pNGAL of 304[IQR 235-358] versus 182[IQR 128 -246]ng/ml with surviving grafts (p<0.001). Time-dependent Receiver operating characteristic analyses at 58 months indicated an Area-Under-the-Curve (AUC) for pNGAL of 0.795, serum creatinine (sCr) based estimated glomerular filtration rate (eGFR) CKD EPI had an AUC of 0.866. pNGAL added to a model based on conventional risk factors for GL with death as competing risk (age, transplant age, presence of donor specific antibodies, presence of proteinuria, history of delayed graft function) had a strong independent association with GL (subdistribution Hazard ratio (sHR) for binary log transfomed pNGAL (log2 (pNGAL)) (3.4 95% CI 2.24-5.15), p<0.0001). This association was substantially attenuated when eGFR was added to the model (sHR for log2 (pNGAL) 1.63 95% CI 0.92-2.88, p=0.095). Category-free net reclassification improvement of a risk model including log2(pNGAL) additionally to conventional risk factors and eGFR was 54.3% (95% CI 9.2 to 99.3%) but C-statistic did not improve significantly. CONCLUSIONS: pNGAL was an independent predictor of renal allograft loss in stable KTR from one transplant center but did not show consistent added value when compared to baseline predictors including the conventional marker eGFR. Future studies in larger cohorts are warranted.
Keywords:Biomarkers, Calprotectin, Graft Survival, Kidney Transplantation, NGAL
Source:Nephrology Dialysis Transplantation
Publisher:Oxford University Press
Page Range:483-495
Date:March 2024
Official Publication:https://doi.org/10.1093/ndt/gfad226
PubMed:View item in PubMed

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