Plasma neutrophil gelatinase-associated lipocalin and Interleukin-18 as predictors of acute kidney injury in renal transplant recipients: A pilot study.

Urine neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL- 18) have shown promise for predicting renal graft recovery. However, urinary flow rate variations may cause variable biomarker dilution. Plasma NGAL and IL-18 may form a biomarker panel that may help predict delayed graft function and slow graft function (SGF) in renal transplant recipients within the first two postoperative days earlier than serum creatinine. There are only a few studies in the literature using plasma NGAL for predicting renal graft recovery. Hence, we planned this study. This observational single-center, prospective cohort study was conducted in renal transplant recipients above 18 years of age. In 22 consecutive renal transplant recipients, we collected ethylenediaminetetraacetic acid-plasma samples 1 h before surgery and subsequently at 6 h, 24 h, and 48 h after surgery for NGAL and IL-18 by sandwich enzyme-linked immuno-sorbent assay technique. Serum creatinine was measured as a part of routine transplant protocol. In renal transplant recipients, neither serum levels of NGAL and IL-18 nor their trends could reliably predict SGF. The only significant correlation existed between serum creatinine at day 2 and IL-18 at day 2 with P = 0.023. Serum NGAL did not correlate with serum creatinine in this setting of renal transplantation. Patients with immediate graft function had a greater percentage decrease of creatinine at day 1 and day 2 (P = 0.002 and 0.001) The percentage change in IL-18 at 24 h and 48 h after transplant from baseline could predict the occurrence of early graft loss (EGL) (P = 0.05, 0.04). The cutoffs were -4.12% at day 1 and +3.39% at day 2 with area under receiver operator characteristics of 0.82 and 0.83, respectively. The percentage change in IL-18 may be a useful marker of EGL in renal transplant recipients. Serum NGAL and creatinine were not able to predict EGL.

Potential Applicability of Perioperative Thromboelastography to Access the Coagulopathies in Live-Related Renal Transplantation - A Prospective Observational Pilot Study.

Ischemic and reperfusion injury (IRI) occurs during organ transplantation. IRI during liver transplantation is well studied and established; results in coagulopathy due to release of heparin-like substances and platelet trapping. During renal transplantation, similar IRI phenomenon occurs, and thromboelastography (TEG) can be used to detect and manage coagulopathy. The preoperative, immediate postreperfusion, and postoperative day 1 TEG was done on 25 cases of live-related renal transplantation. Coagulopathy was defined by deranged and abnormal TEG variables values from baseline and supported by the clinical presence of nonsurgical oozing and bleeding in the surgical field. The postreperfusion TEG values showed coagulopathic changes. About 64% of patients had R-time (RT) more than 12 min, 64% of patients showed maximum amplitude (MA) <55 mm, and 76% of patients had alpha angle <55°. The presurgical TEG clotting index (CI) was +2.45 ± 1.25, postreperfusion CI was -1.96 ± 4.54, and postoperative CI was +4.02 ± 1.35. Univariate analysis revealed that antithymocyte globulin was a significant, but etiology was closure to a significant level as protecting factor, but in multivariate analysis, both variables showed protecting factor with insignificant results. There was a weak correlation between CI with serum creatinine at all time points suggested no linear relationship between serum creatinine and corresponding CI. Hence, the results of study proves that IRI during renal transplant is associated with transient self-limiting coagulopathy, that may be early detected by TEG. CI values in postoperative 24 h apart indicating a hyper-coagulable or prothrombotic state and post-reperfusion CI values show a trend toward hypocoagulable status. No significant effect of different immunosuppression on coagulation and week correlation was found of serum creatinine level (graft function) with CI, which conclude that changes in coagulation have not affected graft function.