Renal transplant recipients as a predictor of graft function serum and urine il-18 (interleukin-18), scd30 (soluble cd30), ngal (neutrophil gelatinase-associated lipocalin) comparison of cystatin c and creatinine levels

Renal transplantation is an exclusive method of treatment because it maintains a longer and qualified life to the patients. The most important cause of graft loss after for renal transplantation is the rejections. Renal biopsy is the golden standart for the diagnosis of rejection it is not frequently used owing to being invasive. The biochemical parameters commonly used to follow up graft functions are; measurement of serum creatinine level and creatinine clearance. But creatinine shows up highly individual variation. It is not a reliable indicator because it is affected of muscle mass changes, muscle metabolism, sex, age, dietary factors such as having much protein, phsical activities and inflammatory process, thus, search for a more reliable and actual indicator is going on. Cystatin C, IL-18, sCD30 and NGAL are important to evaluate the graft function after renal transplantation. In our study, we studied 50 kidney transplant recipients from living donors (13 female, 37 male; mean age ± SD: 38.12 ± 13.67 year). Serum and urine samples from 50 receivers were collected before transplantation and after transplantation on 1. and 7. day, 1. and 3. month. Levels of serum creatinine, cystatin C, IL-18, sCD30, NGAL and urine creatinine, cystatin C, IL-18, sCD30, NGAL were measured. Also urine indicator concentration / urine creatinine ratios were obtained. The patients were divided groups depending on postoperative graft reactivation. We defined DGF as any hemodialysis in the first week after transplant, slow graft function (SGF) as a serum creatinine reduction < 70% by the first week and immediate( early) graft function (IGF) as a reduction ? 70%. Among 50 recipients, 6 had SGF, and 44 had IGF, no patient had delayed graft function. Of 50 recipients, 12 developed acute rejection( AR) and in 38 patients did not observed AR( non-AR). The diagnosis of acute rejection, the high levels of serum creatinine was determined with color Doppler renal ultrasound and biopsy. GFR is calculated by using the creatinine based MDRD, Cockcsoft-Gault, CKD-EPI and cystatin based Larson, Rule formules. GFRMDRD was accepted as reference. A significant strong corelation was observed between creatinine based GFR and cystatin based GFR. Because cystatin C is accepted a more reliable indicator than creatinine, cystatine based GFR can be used instead of creatinine based GFR. After transplantation the levels of serum IL-8 and NGAL, urine IL-8, sCD30, NGAL, cystatin C and urine IL-18/ urine creatinine ratio significantly reduced in the AR, IGF groups and patients who didn?t grow up AR( non-AR); but a significant reduction was not observed in SGF group. In addition, during posttransplant period urine sCD30/ urine creatinine, urine NGAL/ urine creatinine, urine cystatin C/urine creatinine ratios were found to be decreased in IGF and non-AR groups but in AR and SGF groups a significant reduction was not detected for these parameters, they all remained high. Were evaluated with the ROC curve.The area under the ROC curve ( AUC)(95% CI) for predicting AR at the first day was 0.702 (0.544- 0.860) for serum cystatin C, 0.746 (0.591- 0.900) for urine cystatin C and 0.721 (0.561-0.882) for urine creatinine;at the 7th day was 0.785 (0.639-0.932) for serum IL-18, 0.865 (0.764-0.966) for serum cystatin C, 0.839 (0.726-0.952) for serum creatinine, 0.723 (0.546- 0.899) for urine cystatin C and 0.692 (0.525-0.859) for urine cystatin C/ urine creatinine; at the first month was 0.721 (0.558-0.885) for serum creatinine showed a significant for the development of acute rejection. Furthermore, the area under the curve ( AUC)(95% CI) for predicting to GFRMDRD 60 renal clearance at the 7th day was 0.715(0.566-0.864) for serum NGAL; at the first month was 0.677(0.527-0.827) for urine creatinine and 0.668(0.517-0.819) for urine cystatin C/ urine creatinine; at the third month was 0.817(0.694-0.941) for serum cystatin C and 0.929(0.854-1.000) for serum creatinine. As a result, the findings we obtained from this study supports that IL-18, sCD30, NGAL and cystatin C can be used evaluating the graft functions of the renal transplanted patients