Prospective evaluation of cystatin C in the assessment of kidney dysfunction and survival in liver transplant candidates.

IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Stevan A Gonzalez, Nagasri Shankar, Ashwini Mehta, Mauricio Garcia-Saenz-de-Sicilia, Goran B Klintmalm, James F Trotter, Sumeet K Asrani, Bernard V Fischbach, Andres Duarte-Rojo
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引用次数: 0

Abstract

Kidney dysfunction is associated with decreased survival in liver transplant (LT) candidates, yet serum creatinine (sCr) is a poor surrogate for glomerular filtration rate (GFR) in this population. Serum cystatin C (CysC) may provide a more accurate assessment of kidney function and predict outcomes. We performed a multicenter prospective cohort study of consecutive candidates for LT. CysC was obtained at LT evaluation (n = 244), and a subset underwent simultaneous I 125 -iothalamate clearance for measured GFR (mGFR) assessment (n = 137). Patients were followed to assess the need for pre-LT renal replacement therapy, simultaneous liver and kidney transplant, and survival. Estimated GFR (eGFR) based on MDRD-4, GRAIL, Royal Free Hospital Cirrhosis GFR, and the CKD-EPI equations was assessed for bias, precision, and accuracy in reference to mGFR. Receiver operator characteristic (AUROC) and competing risk survival analyses were performed. CysC more accurately discriminated mGFR than sCr at thresholds of ≤60 and ≤30 mL/min/1.73 m 2 with AUROC 0.92 ( p = 0.005) and 0.96 ( p =0.01), respectively. All eGFR equations overestimated GFR, especially among females ( p < 0.05). The GRAIL equation demonstrated the least bias, while CKD-EPI-cystatin C was associated with the greatest precision and lowest frequency of GFR overestimation. Among 165 recipients of LT, CysC discriminated pre-LT renal replacement therapy and the need for simultaneous liver and kidney transplant with AUROC of 0.70 and 0.85, respectively. Cumulative incidence of death, accounting for LT as a competing event, increased with CysC ( p = 0.002) but was not observed with sCr overall or among subgroups ( p = NS). CysC more accurately predicts thresholds of mGFR than sCr in candidates for LT. Elevated CysC discriminates pre-LT renal replacement therapy and simultaneous liver and kidney transplant and is strongly associated with survival in contrast with sCr. CysC is a promising tool to improve prognostication among candidates for LT.

前瞻性评估胱抑素 C 在肝移植候选者肾功能障碍和存活率评估中的应用。
肾功能障碍与肝移植(LT)候选者存活率下降有关,但血清肌酐(sCr)在这类人群中是肾小球滤过率(GFR)的不良替代物。血清胱抑素 C(CysC)可以更准确地评估肾功能并预测预后。我们对连续的 LT 候选者进行了一项多中心前瞻性队列研究。CysC在LT评估时获得(244人),一部分患者同时接受了I125-硫代氨基甲酸清除率的测定,以评估GFR(mGFR)(137人)。对患者进行随访,以评估是否需要进行 LT 前肾脏替代治疗 (RRT)、同步肝肾移植 (SLKT) 和存活率。根据 MDRD-4、GRAIL、皇家自由医院肝硬化 GFR 和 CKD-EPI 方程估算的 GFR(eGFR)参照 mGFR 进行了偏差、精确度和准确性评估。进行了接收者操作特征(AUROC)和竞争风险生存分析。在≤60 mL/min/1.73 m2和≤30 mL/min/1.73 m2的阈值下,CysC比sCr更准确地判别mGFR,AUROC分别为0.92(p=0.005)和0.96(p=0.01)。所有 eGFR 方程都高估了 GFR,尤其是女性(p
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来源期刊
Liver Transplantation
Liver Transplantation 医学-外科
CiteScore
7.40
自引率
6.50%
发文量
254
审稿时长
3-8 weeks
期刊介绍: Since the first application of liver transplantation in a clinical situation was reported more than twenty years ago, there has been a great deal of growth in this field and more is anticipated. As an official publication of the AASLD, Liver Transplantation delivers current, peer-reviewed articles on liver transplantation, liver surgery, and chronic liver disease — the information necessary to keep abreast of this evolving specialty.
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