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411.3 Preoperative Cystatin C predicts acute kidney injury following liver transplantation in patients with normal serum creatinine

Ignacio E Roca, Argentina

Liver transplant unit
Hospital el Cruce "Nestor Kirchner"


Preoperative cystatin C predicts acute kidney injury following liver transplantation in patients with normal serum creatinine

Ignacio Roca1, Fernando FC Cairo1,2, Manuel MB Barbero1, Mercedes MRG Rodriguez Gazari2, Federico FV Villamil1,2.

1Servicio de hepatologia y trasplante hepatico, Hospital el Cruce, Florencio Varela, Argentina; 2Servicio de trasplante hepático, Hospital Britanico, Buenos Aires, Argentina

Introduction: Serum creatinine (Creat) is not a reliable marker of renal function in patients (pts) with cirrhosis mostly because it is highly influenced by several extrarenal factors. In contrast, recent studies showed that cystatin-C (CysC), a renal biomarker produced by all nucleated cells, is a more sensitive marker of decreased GFR than Creat and a good predictor of hepatorenal syndrome. Postoperative acute kidney injury (AKI) increases morbidity and mortality of liver transplantation (OLT). The goal of this study was to evaluate preoperative Cystatin C levels as a predictor of post-OLT AKI in adults with cirrhosis.

Methods: Prospective study including consecutive pts transplanted in two centers from 2019 to 2021. CysC (immunoturbidimetric assay, normal 0.4-0.99 mg/dl) and Creat (mg/dL) were determined upon admission for the transplant and within 12 hours of surgery. Cut-off values for renal dysfunction were > 1.1 for Creat and >1.4 for CysC (selected based on previous reports). Post-OLT renal dysfunction was defined by AKIN criteria assessed 48 hours after surgery. Preoperative, intraoperative and donor variables were analyzed by univariate and multivariate analysis.

Results: The study included 131 pts aged 52 ± 12.5 years (61% males). HCV was the most frequent etiology of cirrhosis (24%) and 35% of pts had hepatocellular carcinoma. Pre-OLT Creat was 0.85 ± 0.42 mg/dL, Cys 1.46 ± 0.46 mg/dL and MELD-Na 20 ± 8. Increased serum Creat was observed in 15/131 pts (11.4%). In contrast, 66/131 pts (50.4%) had CysC values >1.4 mg/dL (p <0.001). Among the 66 pts with elevated CysC, 53 (80.3%) had normal Creat. No deaths occurred before the primary endpoint of the study. The incidence of postoperative AKI was 43.5% (57/131). Among patients with elevated CysC, 39/66 (59.1%) develop AKI compared to 18/65 (27.7%) with normal CysC (p < 0.001). Independent predictors of post-OLT AKI on multivariate analysis were CysC >1.4 (OR 3.47 95% CI 1.35-9.52, p= 0.012), BMI>30 (OR 3.08 95%CI 1.2-8.43, p=0.024), red blood cell transfusions ≥ 5 units (OR 5.93 95%CI 1.65-24.8, p= 0.011) and preoperative hipoalbuminemia < 2.5 gr/dl (OR 3.96 95%CI 1.39-12.1, p= 0.012).

Conclusions: A large proportion of OLT candidates with cirrhosis and normal Creat have elevated levels of CysC that appears to be a better marker of renal dysfunction in this patient population. Preoperative CysC, but not Creat, was a potent predictor of post-OLT AKI. Early preoperative identification by CysC of pts at risk of post-OLT AKI may play an important role at the time of selecting the immunossupressive regimen, using either induction or nephroprotective agents.

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