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  • Title: Alternative definition of acute kidney injury following liver transplantation: based on serum creatinine and cystatin C levels.
    Author: Ling Q, Xu X, Li JJ, Chen J, Shen JW, Zheng SS.
    Journal: Transplant Proc; 2007 Dec; 39(10):3257-60. PubMed ID: 18089366.
    Abstract:
    OBJECTIVE: The aim of this study was to verify the estimation and the predictive abilities of serum creatinine (Cr), serum cystatin C (Cys C), and related formulas for acute kidney injury (AKI). PATIENTS AND METHODS: Thirty patients who underwent cadaveric donor liver transplantation were enrolled in this prospective study. Glomerular filtration rate (GFR) was assessed by the 99mTc DTPA clearance method and estimated by Cr-predicted clearances (Cockcroft-Gault method [CG] and abbreviated Modification of Diet in Renal Disease equation [MDRD]) as well as by 3 other Cys C-based formulas (Hoek, Filler, and Larsson). AKI was confirmed as GFR<80 mL/min/1.73 m2 in the first posttransplantation week. RESULTS: GFR was significantly correlated with reciprocal Cr, reciprocal Cys C, and the 5 formulas (P<.001 for all). The receiver operating characteristic (ROC) area of Cys C was larger than that of Cr (.937 vs .794, P<.05). ROC area of Hoek, or Filler or Larsson was also larger than that of CG or MDRD (.937, .935, .937 vs .802, .849, P<.05 for all). ROC analysis showed the cutoff values were 1.0 mg/dL for Cr and 1.57 mg/L for Cys C. Hoek, Filler, and Larsson equations all underestimated AKI; their optimal cutoff values should be adjusted to 47, 56, and 44 mL/min/1.73 m2, respectively. CONCLUSION: Cys C is a better predictor of AKI than Cr. A value of more than 1.57 mg/L might be considered a new definition of AKI.
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