The assessment of GFR after orthotopic liver transplantation using cystatin C and creatinine-based equations

Doris Wagner, Daniela Kniepeiss, Philipp Stiegler, Sabine Zitta, Andrea Bradatsch, Markus Robatscher, Helmut Müller, Andreas Meinitzer, Astrid Fahrleitner-Pammer, Gerhard Wirnsberger, Florian Iberer, Karlheinz Tscheliessnigg, Gilbert Reibnegger, Alexander R Rosenkranz
Transplant International 2012, 25 (5): 527-36
The measurement of kidney function after orthotopic liver transplantation (OLT) is still a clinical challenge. Cystatin C (CysC) has been proposed as a more accurate marker of renal function than serum creatinine (sCr). The aim of this study was to evaluate sCr- and CysC-based equations including the Chronic kidney disease (CKD)-EPI to determine renal function in liver transplant recipients. CysC and sCr were measured in 49 patients 24 months after OLT. The glomerular filtration rate (GFR) was calculated using the MDRD 4, the Cockroft-Gault, Hoek, Larsson, and the CKD-EPI equations based on sCr and/or CysC. As reference method, inulin clearance (IC) was estimated. Bias, precision, and accuracy of each equation were assessed and compared with respect to IC. Forty-five percent had a GFR < 60 ml/min/1.73 m(2) according to the IC. The Larsson, the Hoek and the CKD-EPI-CysC formula identified the highest percentage of patients with CKD correctly (88%, 88%, and 84%, respectively). The sCr-based equations showed less bias than CysC-based formulas with a similar precision. All CysC-based equations were superior as compared with sCr-based equations in the assessment of renal function in patients with an IC < 60 ml/min/1.73 m(2).

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