ANDRİY V TRAİLİN, MARİNA V PLETEN, TATİANA I OSTAPENKO, NADİİA F IEFİMENKO, OLEXANDER S NİKONENKO
Experimental and Clinical Transplantation - 2017;15(3):267-276
Objectives: Scant information is available on factors for predicting the rate of decline in kidney allograft function beyond 1 year posttransplant. We invest igated whether urinary enzymes (alanine amino transferase, alkaline phosphatase, aspartate aminotransferase, N-acetyl-β-D-hexosaminidase, and γ-glutamyl transpeptidase) in the late postoperative period can predict the decline in estimated glomerular filtration rate. Materials and Methods: In 79 kidney allograft recipients 1 to 17 years after kidney transplant, we assessed a value of urinary enzymes single measurement for predicting the slope of estimated glomerular filtration rate, rapid decline in estimated glomerular filtration rate (> 5 mL/min/1.73 m2/y), and significant decline in estimated glomerular filtration rate (≥ 25% from baseline) during a 2-year period. Results: At baseline, patients with estimated glo - merular filtration rate < 60 mL/min/1.73 m2 (n = 54) differed fromthose with estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2 (n = 25) only in their lower median urinary alanine aminotrans ferase:creatinine ratio (expressed as U/L:mmol/L): 0.055 versus 0.222 (P = .011). Higher urinary activity of aspartate aminotransferase at baseline predicted the negativeslope value for estimated glomerular filtration rate (beta, -0.279; standard error, 0.131; P = .037) and decline in estimated glomerular filtration rate of > 5 mL/min/1.73 m2/year (odds ratio, 2.06; 95% confidence interval, 1.10-3.83; P = .023) over 2 years. It also predicted the drop in estimated glomerular filtration rate ≥ 25% after 1 year (odds ratio, 2.62; 95% confidence interval, 1.07-6.37; P = .034) and 2 years (odds ratio, 2.75; 95% confidence interval, 1.12-6.73; P = .027). Combined with time after transplant, urinary aspartate aminotransferase had good power for predicting an estimated glomerular filtration rate decrease ≥ 25% after 2 years of follow-up. Conclusions: Higher urinary activity of aspartate aminotransferase in the late posttransplant period is useful for identifying transplant patients who are at risk for progressive loss of graft function.
