Estimation of Glomerular Filtration Rate With Serum Cystatin C Accurately Discriminates Renal Dysfunction in Liver Transplant Candidates With End-Stage Liver Disease

S. Gonzalez,¹ J. Trotter,¹ H. Szerlip,² M. Levy,³ A. Chandrakantan,⁴ A. Yango,⁴ A. Rajagopal,⁴ Y. Barri,⁴ K. Rice,⁴ M. Saim,² L. Melton,⁴ M. Emmett,² G. Klintmalm,³ B. Fischbach.⁴

¹Hepatology, Baylor Simmons Transplant Institute, Fort Worth, TX
²Nephrology, Baylor University Medical Center, Dallas, TX
³Transplant Surgery, Baylor Simmons Transplant Institute, Fort Worth, TX
⁴Nephrology, Baylor Simmons Transplant Institute, Fort Worth, TX.

Meeting: 2015 American Transplant Congress

Abstract number: 60

Keywords: Glomerular filtration rate (GFR), Liver cirrhosis, Liver transplantation, Renal dysfunction

Topic:

Session Information

Session Name: Concurrent Session: Optimizing Renal Outcomes in Liver Transplantation

Date: Sunday, May 3, 2015

Session Time: 2:15pm-3:45pm

Presentation Time: 3:15pm-3:27pm

Location: Room 118-AB

Background: Renal insufficiency is common in end-stage liver disease (ESLD) and is linked to survival in patients awaiting liver transplantation. Serum creatinine correlates poorly with measured glomerular filtration rate (GFR) in ESLD. Serum cystatin C may provide an accurate measure of renal function in this population. Methods: Prospective cohort study of consecutive patients with ESLD undergoing liver transplant evaluation. All patients underwent simultaneous assessment of serum cystatin C, serum creatinine, and 24-hour urine collection for creatinine clearance. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) cystatin C estimate for GFR was evaluated vs. serum creatinine in the assessment of renal dysfunction defined by simultaneous I¹²⁵-iothalamate (Glofil-125) clearance. Results: 118 patients were prospectively enrolled and 98 completed the study. Patient characteristics included median age 58 (range 35-72), 65% male, 76% Caucasian, 46% chronic hepatitis C, and 29% hepatocellular carcinoma. Median GFR was 85.8 (range 3.8-203.6) determined by Glofil-125 and 22% had GFR<60. Females were more likely to have GFR<60 (35% vs. 16% of males, p=0.03). The CKD-EPI cystatin C estimate was superior to serum creatinine in discriminating renal dysfunction and was a strong predictor of measured GFR<60 (ROC AUC 0.92, 95% CI 0.83-1.00; p=0.008), GFR<50 (ROC AUC 0.96, 0.91-1.00; p=0.003), and GFR<40 (ROC AUC 0.95, 0.90-1.00; p=0.02). The relationship between CKD-EPI cystatin C and GFR remained highly significant in multivariate analysis involving demographic factors including gender (p<0.01). The inclusion of creatinine in estimation of GFR (CKD-EPI creatinine-cystatin C equation) did not improve discrimination of renal dysfunction (p=NS). Conclusion: Estimation of GFR using serum cystatin C accurately discriminates a wide range of renal dysfunction in patients with ESLD. Serum cystatin C may be used as a reliable marker of renal function in liver transplant candidates.

To cite this abstract in AMA style:

Gonzalez S, Trotter J, Szerlip H, Levy M, Chandrakantan A, Yango A, Rajagopal A, Barri Y, Rice K, Saim M, Melton L, Emmett M, Klintmalm G, Fischbach B. Estimation of Glomerular Filtration Rate With Serum Cystatin C Accurately Discriminates Renal Dysfunction in Liver Transplant Candidates With End-Stage Liver Disease [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/estimation-of-glomerular-filtration-rate-with-serum-cystatin-c-accurately-discriminates-renal-dysfunction-in-liver-transplant-candidates-with-end-stage-liver-disease/. Accessed August 3, 2021.

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