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Article Type

Original Study

Abstract

Objective: The aim of this work is to study the value of urinary neutrophil gelatinase-associated lipocalin (u-NGAL) as an early predictor for the occurrence of acute kidney injury (AKI) in patients undergoing liver transplantation (LT) in comparison with the SCr and RIFLE i (Risk, Injury, and Failure; and Loss; and End-stage kidney disease) classification. Background: Renal dysfunction is common after LT. The incidence of AKI complicating the post-transplant period varies between 48 and 94% and affects both short-term and long-term outcomes. Mortality in those requiring renal replacement therapy may be as high as 40% at 90 days, increasing to 54% at 1 year. Materials and methods: This study was carried on 30 hepatic patients who underwent LT in the National Liver Institute, Menoufiya University, Egypt, in the period from June 2012 to May 2014. Thorough assessment of history, clinical examination and preoperative routine investigations, and baseline renal functions including assessment of GFR by renal scan were performed. Operative data were collected during LT; patients were also assessed 5 days postoperatively for the occurrence of AKI by SCr, urine output and RIFLE classification, and u-NGAL. Results: Fourteen of 30 patients (46.7%) fulfilled the criteria of the RIFLE classification and had AKI; in these patients, there was a significant relation between the RIFLE classification and the cause of LT, preoperative platelet count, the use of basiliximab in the induction of immunosuppression, and day 1, day 2 u-NGAL. u-NGAL levels above the cut-off value of 1300 pg/ml at day 1 and 4440 pg/ml at day 2 are considered good predictors of AKI post-LT, with AUROC 0.77 and 0.77, respectively, with an acceptable accuracy of 66.7 and 73.3%, and high sensitivity and specificity for prediction of AKI post-LT, and correlate significantly with different preoperative and operative parameters. Conclusion: u-NGAL is a valuable marker for early detection of AKI in patients undergoing LT before an increase in SCr occurs. Levels above the cut-off value (1300 pg/ml) have a high sensitivity, specificity, and positive predictive value for AKI after LT.

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