Serum cystatin C, serum creatinine and the MDRD as predictors for renal function defined by the inulin clearance after orthotopic liver transplantation*
BACKGROUND: With improved survival post liver transplantation (LT) a highly sensitive and effective monitoring of post-transplant renal function (RF) is mandatory. The aim of this study was to evaluate the prognostic value of cystatin C on RF measured by the inulin clearance 24 months after LT. METHODS: 98 patients were enrolled, serum creatinine and cystatin C were collected prior to transplantation as well as 1, 6, 9, 12 and 24 months thereafter. The inulin clearance was used as reference standard for renal function with a cut off of 100 mL/min to define renal impairment 24 months after LT. All parameters were compared with respect to the defined cutoff. RESULTS: Univariate analysis showed a prognostic impact of antihypertensive medication prior to transplantation (p = 0.0008) and serum cystatin C one month after liver transplantation (p<0.0001) on renal failure after transplantation. Auroc analysis yielded cystatin C as a superior prognostic parameter compared to creatinine based GFR in predicting renal failure as well as serum creatinine at all time points (AUROC 0.96–0.98). CONCLUSIONS: Our results revealed a high impact of serum cystatin C as an early prognostic biomarker for monitoring renal dysfunction following liver transplantation.
D. Wagner, D. Kniepeiss, P. Stiegler, M. Sereinigg, S. Zitta, S. Schaffellner, E. Jakoby, H. Mueller, F. Iberer, A. Rosenkranz, K. H. Tscheliessnigg, European Surgery 6/2011