Background

There is limited data on outcome of  impact of novel biomarkers urinary neutrophil gelatinise associated lipocalcin (uNGAL ) and serum cystatin C for predicting future major adverse kidney event (MAKE) in liver transplant recipient(LTR).

Methods  

We conducted a single-center, prospective study between 3 Jan 2024 to June 4 2025 on living donor LTR(n = 51). We analysed MAKE (defined as either >25% decline in eGFR, starting chronic dialysis, renal death) MAKE was studied at 90, 180 and 365 days. Biomarkers studied were increase in, uNGAL, or serum cystatin C between baseline and 48 hours post-operative status. We used cox-proportional modelling to estimate multivariate-adjusted hazard ratios (HR) for predictors of MAKE. We also performed competing risk analysis.

Results:

A total of 51 LTR were enrolled in the study with a follow-up of 1 year. The incidence of MAKE90,MAKE180 and MAKE365 in our study was 41%(15/51)29%, 41%, (21/51) and 47%(24/51). MAKE-eGFR decline corresponded 70% of the MAKE events. In adjusted cox hazard proportional analysis, baseline serum cystatin C [HR = 2.1(1.5−3.2); p-value <0.01] was associated with increased MAKE, while baseline uNGAL [ HR = 1.1(0.6-1.4);p-value = 0.56], and change in uNGAL [ HR = 0.9(0.3-1.5);p-value = 0.7],  or change in cystatin C  [ HR = 1.4(0.7-2.4);p-value = 0.6],  was not associated with MAKE.  With competing risk analysis, with death as a competing event the findings were similar. Peri-operative acute kidney disease had higher risk of MAKE while acute kidney injury, and hepatorenal syndrome were not associated with a higher risk of MAKE.

Conclusion: Higher baseline serum cystatin had higher chances of chronic kidney disease within one year of post-liver transplantation, while uNGAL is not helpful in predicting future MAKE. Early intervention by nephrologists in LTR with increased risk can improve the overall LT outcome.