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Glomerular filtration rate assessment in individuals after orthotopic liver transplantation based on serum cystatin C levels
Author(s) -
Schück Otto,
Gottfriedova Halima,
Maly Jan,
Jabor Antonin,
Stollova Milena,
Bruzkova Iva,
Skibova Jelena,
Ryska Miroslav,
Spicak Julius,
Trunecka Pavel,
Novakova Jana
Publication year - 2002
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2002.33957
Subject(s) - renal function , medicine , cystatin c , urology , receiver operating characteristic , creatinine , cyst , liver transplantation , inulin , transplantation , gastroenterology , endocrinology , surgery , chemistry , biochemistry
Individuals after orthotopic liver transplantation (OLT) often show renal dysfunction, which may substantially affect the post‐OLT course. Renal function after OLT is commonly assessed by means of serum creatinine (S cr ) concentration or renal creatinine clearance (C cr ). A glomerular filtration rate (GFR) estimate based on S cr level is not accurate enough because even a more marked decrease in GFR need not be associated with an increase in S cr level, especially in jaundiced patients. The study intends to try to estimate GFR in individuals after OLT by means of determining serum cystatin C (S cyst ) concentrations. In 58 individuals (mean age, 49 ± 7 years; 31 men, 27 women) at various intervals from OLT (mean, 14 ± 10 months), GFR was estimated by using simultaneous determinations of S cyst , S cr , C cr , and renal inulin clearance (C in ). In most subjects (91.3%), C in was decreased to less than the lower limit of normal (80 mL/min/1.73 m 2 ). A significant correlation ( r = 0.70; P < .001) was found between 1/S cyst and C in . Receiver operating characteristic analysis was performed on S cyst and S cr using a C in cutoff value of 80 mL/min/1.73 m 2 . The area under the curve for S cyst was 0.912 ± 0.044, and that for S cr , 0.899 ± 0.049. There was no statistically significant difference between these values. The sensitivity for a S cyst level of 1.20 mg/L (upper limit of normal value) to detect a decrease in GFR (measured as C in ) below the lower limit of normal (80 mL/min/1.73 m 2 ) was 96.1%. The sensitivity of S cyst level was significantly greater ( P < .01) than the sensitivity of S cr level for men and at borderline significance for women ( P = .05). Findings support the assumption that a S cyst level less than 1.2 mg/L indicates with a high degree of probability ( P < .001) that GFR is not decreased to less than the normal limit. S cyst assessment in individuals after OLT could be proposed as a confirmatory test of a decrease in GFR in individuals with normal S cr levels. (Liver Transpl 2002;8:594‐599. )