The Predictive Value of Serum NGAL for the Diagnosis of Delayed Graft Function in Kidney Transplantation

Introduction: The role of serum neutrophil gelatinase-associated lipocalin (NGAL) in predicting delayed graft function (DGF) after kidney transplantation is poorly defined. The objective of this study was to evaluate the serum NGAL expression in the early postoperative phase after kidney transplantation and compare it with serum creatinine (Cr). Methods: We studied 29 patients who received kidney transplantation from deceased (n=24) and lived (n=5) donors from October 2017 to December 2018 at the Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Serum NGAL, Serum Cr, and urine output were measured at 1 to 7 days after transplantation. The need for dialysis in one week after transplantation was evaluated. Results: Among 29 recipients with serum biomarkers measurements, 8 (27.5%) developed DGF (need to hemodialysis within one week of transplantation). Resulted in areas under ROC curves (AUCs) for serum NGAL at early hours following transplantation was (0.839, 95% CI: 0.69-0.98, P-value=0.005) that could accurately predict DGF compared to urine output (0.747, 95% CI: 0.55-0.93, P-value=0.045) and serum Cr (0.607, 95% CI: 0.34-0.86, P-value=0.398) at 24 hours after transplantation. Multivariate analysis revealed that only serum NGAL was a significant independent predictor of DGF (OR: 0.996, 95% CI: 0.993-1.000, P-value=0.039). Conclusion: Serum NGAL at early hours of post-transplantation was a valuable biomarker for an early accurate predictor of DGF in kidney transplantation compared with traditional biomarkers such as serum Cr and urine output.