Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker for acute kidney injury. This study was conducted to determine the clinical implications of perioperative plasma NGAL in relation to renal function after living donor nephrectomy.

Methods: Between July 2013 and May 2014, 112 donors in our institution underwent live donor nephrectomy. Donor plasma NGAL was measured perioperatively until 6 month, and changes in perioperative plasma NGAL was investigated. The relationships between perioperative plasma NGAL and recovery of renal function were analyzed. Renal function was estimated with the Modification of Diet in Renal Disease (MDRD) formula.

Results: Mean preoperative NGAL was 62.1±29.5 ng/mL. Plasma NGAL was most elevated at 1 week postoperatively (218±95.5 ng/mL) and stabilized after 1 month (122.9±45.3 ng/mL). Preoperative plasma NGAL was not correlated with donor age (r=0.061, p=0.524) and preoperative eGFR (r=-0.164, p=0.084), but correlated with 6-month eGFR (r=-0.458, p<0.001). During the observation period, plasma NGAL at 1 week was most correlated with 6-month eGFR (r=-0.554, p<0.001). An ROC curve analysis showed that age, preoperative eGFR, and 1-week postoperative plasma NGAL were highly predictive of developing of chronic kidney disease (CKD; eGFR<60 ml/min/1.73m2) at 6 month postoperatively (AUC=0.91; p<0.001). One-week postoperative plasma NGAL was associated with CKD at 6 month (odds ratio: 1.13 for each 10 ng/ml increase; p=0.013).

Conclusion: Plasma NGAL becomes elevated after kidney donation and can provide information about acute kidney injury during the compensatory hyperfiltration period. Donors with a perioperatively increased plasma NGAL require close observation because there may be a greater possibility of CKD developing after donation.

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