期刊
KIDNEY INTERNATIONAL
卷 84, 期 6, 页码 1214-1225出版社
ELSEVIER SCIENCE INC
DOI: 10.1038/ki.2013.200
关键词
delayed graft function; diagnosis; kidney transplantation; outcomes; renal transplantation
资金
- Medical Research Council, Kidney Research UK
- Yorkshire Kidney Research Fund
- Leeds Teaching Hospitals Charitable Foundation
- NIHR [RP-PG-0707-10101]
- MRC [G0802416, G0701382] Funding Source: UKRI
- Medical Research Council [G0802416, G0701382] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0509-10020, RP-PG-0707-10101] Funding Source: researchfish
Early identification and prognostic stratification of delayed graft function following renal transplantation has significant potential to improve outcome. Mass spectrometry analysis of serum samples, before and on day 2 post transplant from five patients with delayed graft function and five with an uncomplicated transplant, identified aminoacylase-1 (ACY-1) as a potential outcome biomarker. Following assay development, analysis of longitudinal samples from an initial validation cohort of 55 patients confirmed that the ACY-1 level on day 1 or 2 was a moderate predictor of delayed graft function, similar to serum creatinine, complementing the strongest predictor cystatin C. A further validation cohort of 194 patients confirmed this association with area under ROC curves (95% CI) for day 1 serum (138 patients) of 0.74 (0.67-0.85) for ACY-1, 0.9 (0.84-0.95) for cystatin C, and 0.93 (0.88-0.97) for both combined. Significant differences in serum ACY-1 levels were apparent between delayed, slow, and immediate graft function. Analysis of long-term followup for 54 patients with delayed graft function showed a highly significant association between day 1 or 3 serum ACY-1 and dialysis-free survival, mainly associated with the donor-brain-dead transplant type. Thus, proteomic analysis provides novel insights into the potential clinical utility of serum ACY-1 levels immediately post transplantation, enabling subdivision of patients with delayed graft function in terms of long-term outcome. Our study requires independent confirmation.
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