Background: Predicting post-liver transplant (LT) recovery of renal dysfunction (RD) remains a significant clinical challenge. Biomarkers predictive of recovery would be helpful in the management of pre-LT patients with RD and would complement clinical and laboratory data in decision algorithms regarding the need for a simultaneous liver-kidney (SLK) transplant.

Aim: To validate a previously identified association between plasma proteomic biomarkers and post-LT renal recovery in patients with distinct clinical phenotypes: Hepato-Renal Syndrome (HRS), non-HRS Acute Kidney Injury (AKI), and Chronic Kidney Disease (CKD).

Methods: Using a novel renal injury proteomic panel of 13 proteins from Myriad/RBM, Inc., plasma samples were collected at the time of transplant in patients clinically stratified into 4 groups (clinical phenotypic stratification was achieved using both pre- and post-LT clinical and laboratory data). HRS (Group 1): RD clinically characterized as HRS, recovered post-LT; non-HRS AKI (Group 2): RD not clinically characterized as HRS, did not fully recover RD post-LT; CKD (group 3): known CKD, received SLK; A negative control group consisted of patients with no pre-LT RD (Group 4).

Results: Two plasma proteins (Osteopontin, OPN; Vascular Endothelial Growth Factor, VEGF) were elevated in both Group 1 (HRS) and Group 2 (non-HRS AKI) (Bonferroni-adjusted p-values < 0.05). However, only OPN was uniquely elevated in patients with HRS, whose RD recovered fully within 6 weeks of transplantation (p<0.05).

Conclusion: These data validate our previous findings suggesting that plasma OPN levels are associated with the HRS clinical phenotype and may be used as a predictive biomarker for recovery of RD post-LT.

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