Predicting Outcomes for Kidney Transplant Patients

Monday, January 01, 0001

A new study in the American Journal of Transplantation cites evidence in favor of using the protein biomarkers NGAL and IL-18 as a means to determine whether kidney transplant patients will require dialysis within the first week of transplant surgery.

In a study published in 2005 in the journal Lancet, Prasad Devarajan, MD, director of the Division of Nephrology and Hypertension at Cincinnati Children's Hospital Medical Center, identified the protein NGAL (neutrophil gelatinase-associated lipocalin) that could be used to predict kidney failure in patients who underwent heart surgery. Now, the same test has proven equally effective in predicting whether a new kidney will or will not work in a transplant patient.

More than 65,000 people in the United States are waiting for kidney transplants. A diagnostic test like this is important because four to 10 percent of patients who receive kidneys from a living donor, and five to 50 percent of patients who receive kidneys from deceased donors, will experience kidney failure after transplant surgery.

"These patients have been struggling with kidney failure for a long time, and even after they get a transplant, they can still get into trouble. Prior to these studies on NGAL, we did not have an objective tool to determine immediate post-operative patient outcomes," Dr. Devarajan said.

The new study, which is based on 53 patients, shows the lower the NGAL value, the faster the recovery period. Equally true, the higher the NGAL value, the longer the recovery period and the greater the risk for developing kidney failure.

Currently, kidney failure is determined by measuring the serum creatinine, but creatinine is an unreliable indicator during acute kidney injury and does not reflect the degree of damage until a steady state has been reached, which may be several days. Dependable diagnostic testing is currently not available for the early prediction of kidney failure following kidney transplantation.

"It is important to try and improve the outcome for kidney transplant patients. We believe NGAL and IL-18 will lead to new diagnostic tools to identify patients who will need additional therapies," Dr. Devarajan said.

This study was funded with grants from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health; March of Dimes Foundation; American Heart Association Ohio Valley Affiliate; and a Translational Research Initiative Grant from Cincinnati Children's.

Cincinnati Children's is a 475-bed institution devoted to bringing the world the joy of healthier kids. Cincinnati Children's is dedicated to transforming the way health care is delivered by providing care that is timely, efficient, effective, family-centered, equitable and safe. It ranks third nationally among all pediatric centers in research grants from the National Institutes of Health. The Cincinnati Children's vision is to be the leader in improving child health.