Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jun 21, 2009; 15(23): 2913-2917
Published online Jun 21, 2009. doi: 10.3748/wjg.15.2913
Microproteinuria for detecting calcineurin inhibitor-related nephrotoxicity after liver transplantation
Jing Li, Bin Liu, Lu-Nan Yan, Lan-Lan Wang, Wan Y Lau, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Jia-Yin Yang, Fu-Gui Li
Jing Li, Department of Anesthesiology and Critical Care Medicine, West-China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Bin Liu, Lu-Nan Yan, Bo Li, Wen-Tao Wang, Ming-Qing Xu, Jia-Yin Yang, Fu-Gui Li, Division of Liver Transplantation, West-China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Lan-Lan Wang, Department of Clinical Immunological Laboratory, West-China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Wan Y Lau, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
Author contributions: Li J and Liu B took care of the patients, designed the study, collected and analyzed the data, and wrote the manuscript; Yan LN designed the study, collected and analyzed the data, and wrote the manuscript; Wang LL collected and analyzed the data, coordinated the work group and contributed to the discussion; Lau WY contributed to the discussion; Li B, Wang WT, Xu MQ, Yang JY, Li FG took care of the patients, collected and analyzed the data.
Correspondence to: Lu-Nan Yan, Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China. surgeryliubin@163.com
Telephone: +86-28-85422867
Fax: +86-28-85423724
Received: March 19, 2009
Revised: April 27, 2009
Accepted: May 4, 2009
Published online: June 21, 2009
Abstract

AIM: To investigate whether microproteinuria could be used as an early and sensitive indicator to detect calcineurin inhibitor (CNI)-related nephrotoxicity after liver transplantation.

METHODS: All liver transplant recipients with normal serum creatinine (SCr) and detectable microproteinuria at baseline were included in this study. The renal function was monitored by the blood clearance of 99mTc-diethylenetriaminepentaacetic acid every 6 mo. Microproteinuria, SCr and blood urea nitrogen (BUN) were measured at entry and at subsequent follow-up visits. The patients were divided into different groups according to the mean values of glomerular filtration rate (GFR) at the follow-up time points: Group 1, GFR decreased from baseline by 0%-10%; Group 2, GFR decreased from baseline by 11%-20%; Group 3, GFR decreased from baseline by 21%-40%; Group 4, GFR decreased from baseline by > 40% and/or SCr was increasing.

RESULTS: A total of 143 patients were enrolled into this study (23 females and 120 males). The mean follow-up was 32 mo (range 16-36 mo). Downward trends in renal function over time were observed in the study groups. SCr and BUN increased significantly only in Group 4 patients (P < 0.001). β2-microglobulin (β2m) and α1-microglobulin (α1m) significantly increased with the subtle change of renal function in recipients who were exposed to CNI-based immunosuppression regimens. The reductions in GFR were closely correlated with elevated α1m (r2 = -0.728, P < 0.001) and β2m (r2 = -0.787, P < 0.001).

CONCLUSION: β2m and α1m could be useful as early and sensitive indicators of CNI-induced nephrotoxicity.

Keywords: Microproteinuria; Liver transplantation; Calcineurin inhibitors; Nephrotoxicity