A. Kandus

Functional Status of Hemodialysis Arteriovenous Fistula in Kidney Transplant Recipients as a Predictor of Allograft Function and Survival

There is no accepted policy for preserving or ligating arteriovenous fistula (AVF) after successful kidney transplantation. The aim of this study was to compare kidney graft function and survival between patients with a functional AVF at 1 year after-transplantation with those having a nonfunctional AVF. This historical cohort study included 311 kidney transplant recipients between January 2000 and December 2008 with a functional AVF at the time of transplantation. Patients were divided into 2 groups according to functional status of AVF at 1 year after transplantation. Graft function was assessed at 1 year by serum creatinine and estimated glomerular filtration rate (eGFR) using the 4-variable Modification of Diet in Renal Disease formula. Kaplan-Meier and Cox proportional hazards analyses were used to assess the relationship between the functional status of the AVF and graft survival. The 311 recipients had a mean age of 47 ± 11 years (range, 14 to 70) with 188 (60.5%) males. Patients with functional AVF at 1 year (n = 239) showed higher serum creatinine and lower eGFR values than those with nonfunctional AVF (n = 72): namely 110 ± 38 μmol/L and 69 ± 21 mL/min/1.73 m(2) versus 99 ± 30 μmol/L and 74 ± 19 mL/min/1.73 m(2), respectively (P < .05). Persistence of a functional AVF at 1 year after transplantation was associated with a greater incidence of eGFR <60 mL/min/1.73 m(2) compared with nonfunctional AVF: 36.8% versus 23.6% (odds ratio, 1.885; 95% confidence interval [CI], 1.031-3.450; P = .038). The 5-year allograft survival rates were 60% among patients with a functional AVF versus 75% among those with a nonfunctional AVF (P = .045). The adjusted analyses revealed the persistence of a functional AVF to be associated with an increased risk for future allograft loss (hazard ratio, 1.336; 95% CI, 1.018-1.755; P = .037). In conclusion, the persistence of a functional AVF was associated with a lower eGFR at 1 year after-transplantation and an increased risk for future allograft loss.

Acute Renal Failure Due to Hemorrhagic Fever with Renal Syndrome

The aim of our study was to analyze the clinical course and outcome of acute renal failure (ARF) in patients with hemorrhagic fever with renal syndrome (HFRS). From 1983 to 1995, we treated 33 patients (27 males, 6 females) aged from 16 to 71 years. Half of patients were connected with work at a farm or in a forest. The disease was confirmed serologically with indirect immunofluorescence test (IFT) and enzyme-linked immunosorbent assay (ELISA). In 18 patients percutaneous kidney needle biopsies were analyzed. In 85% of the cases, the disease broke out from June to October. The most frequently expressed clinical signs and symptoms were fever, nausea/vomiting, headache, backache, abdominal pain, myalgia, diarrhea, conjunctival injection, and hemorrhages. Four patients had concomitant pancreatitis. In 25 patients, oliguria was present, and transient hemodialysis treatment was needed in 19 patients. Infection with Hantaan virus was established in 20 patients and with Puumala virus in 13 patients. At renal biopsy, acute interstitial nephritis accompanied with hemorrhages and necrosis was found, and at a later biopsy there were also signs of interstitial fibrosis. All patients were cured, but renal function was not completely recovered in some. We conclude that ARF is a serious complication in patients with HFRS. Although not lethal in our group of patients, many of them showed severe signs and symptoms of illness. Transient hemodialysis was necessary in two-thirds of the patients. Some degree of functional defects and morphological changes might persist.

Plasmapheresis and immunoadsorption for treatment and prophylaxis of recurrent focal segmental glomerulosclerosis in adult recipients of deceased donor renal grafts.

Recurrent focal segmental glomerulosclerosis has a great impact on kidney graft survival. This retrospective study presents immunoadsorption‐plasmapheresis treatment and outcome in our renal graft recipients with significant post‐transplant proteinuria (>1 g/day) and focal segmental glomerulosclerosis in native kidneys. Recurrence was defined as occurrence of nephrotic range proteinuria or biopsy‐confirmed diagnosis. Successful treatment was defined as sustained reduction of proteinuria to <1 g/day. From 2000 through 2011, 548 adult patients received kidney grafts from deceased donors. In 20 of these patients (3.6%) end‐stage renal disease was a consequence of focal segmental glomerulosclerosis. Recurrence was confirmed in five of seven treated patients. Immunoadsorption‐plasmapheresis treatment was successful in five patients (70%). Their age at disease diagnosis in native kidneys was 12 to 44 years. Time to end‐stage renal disease was 3 to 14 years. Recipient age at transplantation was 21 to 61 years. Onset of significant proteinuria was 2 to 87 days after transplantation. Immunoadsorption or plasmapheresis started 1 to 7 days after recurrence of significant proteinuria. Treatment period was 1 to 103 months and 12 to 206 procedures were performed per patient. Follow‐up period after cessation of plasmapheresis was 11 to 58 months. Final urine protein/creatinine ratio was 8.8 to 98.0 mg/mmol and final serum creatinine was 63 to 148 μmol/L. Follow‐up after transplantation was 18 to 135 months. One patient was still on treatment. One graft was lost to recurrence. No serious adverse effects occurred during immunoadsorption and plasmapheresis. Immunoadsorption and plasmapheresis appears to be successful in the majority of patients, probably due to their early start.

Does Pretransplant Soluble CD30 Serum Concentration Affect Deceased-Donor Kidney Graft Function 3 Years After Transplantation?

Elevated serum concentrations of soluble CD30 molecule (sCD30) have been related to acute cellular rejection and poor graft outcomes in kidney transplantation. This historical cohort study investigated the association of pretransplant sCD30 serum concentrations with kidney graft function expressed as estimated glomerular filtration rate (GFR) at 3 years after transplantation. Pretransplant sera from 176 adult deceased-donor kidney graft recipients were tested for sCD30 content using a commercially available automated enzyme-linked immunosorbent assay. The immunosuppression consisted of induction therapy with monoclonal anti-CD25 antibodies and a maintenance regimen of cyclosporine (CsA)-based therapy. GFR was estimated (eGFR) by the four-variable Modification of Diet in Renal Disease (MDRD) Study equation. According to the distribution of pretransplant sCD30 levels (median 66.7 U/mL; interquartile range, 46.6 to 98.6 U/mL), a concentration of 66 U/mL or higher was defined as high (n = 89) and below 66 U/mL as low (n = 87). Three years after transplantation, eGFR was not significantly different among recipients in high versus low sCD30 groups (69 +/- 23 mL/min/1.73m2 vs 66 +/- 21 mL/min/1.73m2; P = .327) and there was no correlation between eGFR and pretransplant sCD30 levels (r2 = 0.001; P = .73). Upon multivariate regression analysis, donor age, recipient body mass index at transplantation, and acute rejection episodes were independent variables affecting eGFR at 3 years after transplantation. This study showed that pretransplant sCD30 serum concentrations were not associated with deceased-donor kidney graft function at 3 years after transplantation. The immunosuppression with anti-CD25 antibodies and a triple CsA-based maintenance regimen could possibly be decisive for our findings.

Prevention of Early Acute Rejection With Daclizumab and Triple Immunosuppression in Cadaveric Renal Allograft Recipients

Abstract:  We carried out a prospective study of the safety and efficacy of daclizumab combined with triple immunosuppression in adult recipients of at least one HLA‐mismatched cadaveric renal allograft. All studied patients received the same immunosuppression: a daclizumab infusion of 1 mg/kg immediately before transplantation, and at 2, 4, 6, and 8 weeks following the transplantation. Infusion of cyclosporine (CsA) (0.08 mg/kg/h) was started at the time of the operation and continued by CsA microemulsion (CsA‐Neoral), 3 mg/kg twice daily on day 2, methylprednisolone, 0.4 mg/kg intravenously at operation, and mycophenolate mofetil started on day 1. The dose of CsA‐Neoral was adjusted to maintain target blood trough levels. Oral methylprednisolone was tapered by 4 mg per week to achieve a maintenance dose of 0.08 mg/kg/day. Fifty‐five patients, with a mean age of 48 ± 11 years, were studied. Six of them received a second renal allograft. The mean donor age was 38 ± 14 years. Mean cold ischemia time was 19.5 ± 6.5 h, mean value of HLA‐antigen mismatches was 2.7 ± 0.9, mean latest PRA value was 3 ± 7%. Fifteen patients experienced delayed graft function. During a follow‐up period of 3 months three acute rejection episodes occurred. One patient died because of systemic aspergillosis. After 3 months mean serum creatinine was 104 ± 38 µmol/L. Five renal allografts failed, one of them due to rejection. Patient and graft survival was 98.2% and 90.9%, respectively. Daclizumab with this triple therapy represents safe and efficient immunosuppression strategy, demonstrated with low incidence of early acute rejection episodes and an acceptable adverse event profile in cadaveric renal allograft recipients.

Epoetin Responsiveness in Peritoneal Dialysis Patients: A Multi-center Slovenian Study

Abstract:  The objective of our study was to assess the influence of residual renal function and other factors on epoetin requirements in chronic peritoneal dialysis patients. Fifty‐one stable patients (mean age ± SD: 52 ± 13 years; 20 women) without recent bleeding, bone marrow disease or malignancy were recruited in four Slovenian centers. The target hemoglobin was above 110 g/L. The peritoneal equilibration test results and relevant clinical and laboratory parameters were recorded. The epoetin resistance index was expressed as a weekly epoetin dose/body weight/hemoglobin concentration. Twenty‐four percent of the patients did not need epoetin treatment, the rest were treated with epoetin‐beta in a dose of 70 ± 56 U/kg per week s.c.; the hemoglobin concentration was 124 ± 15 g/L. Ferritin >100 µg/L and transferrin saturation >20% fulfilled 63% of patients whose epoetin resistance index was not significantly lower (0.43 ± 0.5 U/kg per week per g/L vs 0.6 ± 0.72 U/kg per week per g/L, P = 0.502). No difference was found between diabetic and non‐diabetic patients. Treatment with angiotensin system antagonists, but not with aluminum phosphate binders, was associated with increased epoetin resistance index (0.56 ± 0.59 vs 0.3 ± 0.4 U/kg per week per g/L, P = 0.038). No correlation between epoetin resistance index and residual glomerular filtration rate was found (r = −0.2, P = 0.173). A multiple linear regression analysis showed C‐reactive protein, intact parathormone level, female sex and treatment with angiotensin system antagonists to be the independent predictors influencing epoetin resistance index. Our results show that systemic inflammation, secondary hyperparathyroidism and angiotensin system antagonist treatment are the most important modifiable parameters affecting epoetin requirements in stable peritoneal dialysis patients.

Beta 2-microglobulin elimination characteristics during hemofiltration with acrylonitrile and polysulfone membrane hemofilters.

Elimination characteristics of beta 2- microglobulin (BMG) during hemofiltration (HF) with acrylonitrile (AN69) and polysulfone (PS) hemofilters were investigated in a prospective clinical investigation. Seven chronic uremics on regular HF were treated for 4 weeks, three times a week, with AN69 hemofilters. The study was then repeated with PS hemofilters. There were no significant differences in the patients’ body weight, the ultrafiltrate volume per session, and the duration of each HF session between both treatments. At the start of HF, arterial plasma concentration of BMG was (for AN69) 33.5±4.0 mg/L (mean±SD) and (for PS) 35.8±6.5 mg/L (NS); at the end of HF it was (for AN69) 11.0±1.8 mg/L and (for PS) 17.5±4.2 mg/L (p<0.001). The amount of BMG in total ultrafiltrate was (for AN69) 179.3±22.6 mg and (for PS) 140.6±26.8 mg (p<0.02). With AN69 hemofilter, maximum BMG plasma clearance and sieving coefficient were 51.0±9.5 mL/min’ and 0.42±0.04 at 60 minutes. With PS hemofilter, maximum BMG plasma clearance and sieving coefficient were 37.4±5.7 mL/min and 0.27±0.03 at 15 minutes. Twenty-two percents of BMG entering the AN69 hemofilter at 15 minutes were adsorbed on the membrane (p<0.001). BMG elimination with the AN69 hemofilter was more efficient than with the PS hemofilter. Long-term studies will be necessary to demonstrate whether this difference is of any clinical significance.

Subclinical Left Ventricular Echocardiographic Abnormalities 1 Year after Kidney Transplantation Are Associated with Graft Function and Future Cardiovascular Events

Cardiovascular events (CVE) are the leading cause of mortality in kidney transplant recipients. Increased left ventricular mass (LVM) is a risk factor for CVE. This study investigated the associations of LVM with impaired kidney graft function expressed as lower glomerular filtration rate (GFR) at 1 year after transplantation and future CVE beyond 1 year. The prospective study cohort included 68 nondiabetic recipients of a kidney transplant between January 2004 and December 2005 who underwent a transthoracic echocardiographic investigation at 1 year after transplantation. LVM and left ventricular hypertrophy (LVH) were assessed using 2-dimensional M-mode echocardiography. GFR was estimated (eGFR) by the 4-variable Modification of Diet in Renal Disease formula. Cox proportional hazards analysis was used to estimate cardiac CVE (angina pectoris, acute myocardial infarct, coronary angioplasty or bypass surgery, or sudden cardiac death) hazard ratios (HRs) for patients with LVH versus control subjects with no LVH at 1 year after transplantation. All patients had normal systolic function (ejection fraction >50%) with no symptoms or signs of heart failure. LVH was present in 44 patients (65%). LVM and incidence of LVH were increased in 28 patients with eGFR <60 mL/min/1.73 m(2) compared with 40 patients with eGFR ≥60 mL/min/1.73 m(2) (248 ± 61 g and 86% vs 210 ± 46 g and 50%, respectively; P < .01). After a median follow-up of 4.5 years, there were 18 (26.5%) cardiac CVE. The incidence of CVE was higher in patients with LVH than in patients with no LVH at 1 year after transplantation (36.4% vs 8.3%; P = .020). In adjusted analyses, LVH was associated with an increased risk for future CVE (HR, 4.69; 95% confidence interval, 1.02-21.5; P = .037). In kidney transplant recipients, a lower eGFR at 1 year after transplantation was associated with greater LVM and higher incidence of LVH. Presence of LVH was associated with an increased risk for future CVE.

Early Kidney Graft Size and Doppler Parameters Are Associated With Kidney Graft Function 1 Year After Transplantation

BACKGROUND The aim of this study was to assess the association of various ultrasonography (US) and Doppler parameters of kidney graft as measured at 1 month posttransplant with 1-year graft function. MATERIALS AND METHODS The study cohort included 125 adult recipients of deceased donor kidney transplantations between January 2006 and February 2009. All patients underwent an US-Doppler examination performed by a trained nephrologist at 1 month posttransplant using an Acuson-Siemens Sequoia 512. Graft length and intrarenal Doppler indices were measured at the midsegmental artery level. Relative graft size was calculated by dividing graft length with body mass index. Graft function was assessed at 1 year by estimated glomerular filtration rate (eGFR) using the 4-variable Modification of Diet in Real Disease study equation. Linear and logistic regression analyses were used to assess the relationship between US-Doppler parameters and eGFR. RESULTS Univariate linear regression showed a significant correlation between eGFR at 1 year and graft length at 1 month (P = .009), relative graft length <0.50 cm per kg/m(2) (P = .004), resistance index >0.75 (P = .031), and end-diastolic velocity <9 cm/sec (P = .006). Logistic regression analyses showed that eGFR <60 mL/min/1.73 m(2) at 1 year was significantly associated with graft length <12 cm at 1 month (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.16-4.92; P = .017), relative graft length <0.5 cm per kg/m(2) (OR, 2.54; 95% CI, 1.20-5.35; P = .014), resistance index >0.75 (OR, 2.86; 95% CI, 1.30-6.29; P = .009), and end-diastolic velocity <9 cm/sec (OR, 2.37; 95% CI, 1.01-5.56; P = .047). CONCLUSION In this retrospective analysis, kidney transplant recipients with greater graft length at 1 month, specifically when standardized to body size, showed better graft function at 1 year posttransplantation. Higher intrarenal diastolic blood flow and lower resistance index at 1 month were also predictive of better graft function at 1 year.

Estimated Protein Excretion Rate From Second Morning Spot Urine Protein-Creatinine Ratio: A Diagnostic Study in Kidney Transplant Recipients.: Abstract# C1737

C1737 Estimated Protein Excretion Rate From Second Morning Spot Urine Protein-Creatinine Ratio: A Diagnostic Study in Kidney Transplant Recipients. M. Mrevlje,1 J. Lindic,1 G. Mlinsek,1 A. Kandus,1,2 M. Arnol.1,2 1Department of Nephrology, University Medical Centre, Ljubljana, Slovenia; 2Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. Background. Protein-creatinine ratio (PCR) in spot urine samples is recommended for proteinuria screening instead of measured 24-hr protein excretion. A second morning urine sample is more convenient to collect than the first one. We hypothesized that estimated protein excretion rate (ePER) using second morning spot PCR and estimated creatinine excretion rate (eCER) accurately predicts 24-hr protein excretion in kidney transplant recipients. Methods. Second morning spot PCR was measured in 572 prevalent transplant recipients at least 3 months post-transplant. Proteinuria (PCR>20 mg/mmol) was present in 190 patients (33%). PCR and 24-hr urine protein excretion were measured in 161 recipients who consented for the study. ePER was calculated as the product of PCR and eCER. Percent bias ([measured–estimated value/measured value]x100), precision (standard deviation of the mean bias), and accuracy (within 30% of 24hr collection) were calculated for the following values of 24-hr protein excretion: 150–299, 300–499, 500–999 and ≥1000 mg/d. Receiver operator characteristic curves were used to obtain the best sensitivity and specifi city of ePER at the selected cutoff values. Results. Mean age was 55 years, mean 24-hr creatinine clearance was 53 ml/min, median PCR 52 mg/mmol, median ePER 457 mg/d, and median 24-hr protein excretion 480 mg. The ePER tended to overestimate 24-hr protein excretion, and relative overestimation was greatest with the smallest amount of proteinuria. 24-hr protein excretion, mg/d Percent bias (95% CI), % Precision (95% CI), mg/d Accuracy, % 150-299 (n=42) -72 (-107−-37) 195 (165−226) 45 300-499 (n=41) -4 (-12−14) 235 (198−272) 54 500-999 (n=45) -1 (-15−13) 343 (292−394) 53 ≥ 1000 (n=33) -12 (-44−20) 1154 (901−1407) 64 The ePER had good discriminatory ability to predict 24-hr protein excretion >300, >500, and >1000 mg with area under the curve of 0.94, 0.97, and 0.98, respectively. ePER cutoff values of 350, 650, and 1100 mg/d had the highest sensitivity and specifi city to predict proteinuria >300, >500, and >1000 mg/d (90% and 78%, 90% and 92%, and 92% and 98%, respectively). Conclusion. In kidney transplant recipients, ePER in second morning spot urine accurately predicts 24-hr protein excretion >300 mg. However, ePER >1000 mg/d is less precise and 24-hr urine collection should be considered before clinical decisions. Abstract# C1738 Prognostic Value of Post-Transplantation Proteinuria for Cardiovascular Outcomes in Kidney Transplant Recipients. H. Jeon,1 J. Hwang,1 H. Kim,3 S. Park,3 K. Joo,1 C. Lim,2 Y. Oh,2 C. Ahn,1 Y. Kim,1 J. Lee.2 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Republic of; 2Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea, Republic of; 3Department of Internal Medicine, Ulsan University College of Medicine, Seoul, Korea, Republic of. Background: Proteinuria has been shown to be associated with mortality, progression to kidney failure, and cardiovascular disease events in general population. Herein, we have analyzed the effect of proteinuria on cardiovascular outcomes, graft loss, and mortality in kidney transplant recipients (KTRs). Methods: We performed a retrospective multi-center study to evaluate the effect of post-transplantation proteinuria on cardiovascular outcomes, graft loss, and patients’ survival. This study enrolled a total of 2052 KTRs in Seoul National University Hospital and Asan Medical Center, and patients were classifi ed into three groups according to the amount of proteinuria (<150mg/day [group 1] vs. 150-1500mg/day [group 2] vs. >1500mg/day [group 3]). The primary endpoint was major adverse cardiac events (MACE), defi ned as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Results: The mean age of the recipients was 43.6 ± 11.4 years, and 58.6% were male. During a median 55.3-month follow-up, there were 38 (1.9%) cases of MACE, 71 (3.5%) graft loss, and 44 (2.1%) deaths. In a Cox model adjusted with multiple covariates, proteinuria was signifi cantly associated with MACE (group 1 [reference] vs. group 2 [HR 3.29, CI 1.02-10.60, P = 0.046] vs. group 3 [HR 5.81, CI 1.2826.31, P = 0.022]). KTRs with higher proteinuria showed signifi cantly higher graft loss rate than those without proteinuria (group 1 [reference] vs. group 3 [HR 3.97, CI 1.65-9.56, P = 0.002]). However, there was no signifi cant association between proteinuria and all-cause mortality. KTRs with proteinuria showed a greater number of acute rejection episodes (10.5% [group 1] vs. 20.5% [group 2] vs. 37.1% [group 3], P < 0.001) Conclusion: Post-transplantation proteinuria is a strong prognostic factor for cardiovascular outcomes among KTRs. Therefore, evaluation and management of proteinuria should be considered to improve graft and patients outcomes. C1738 Prognostic Value of Post-Transplantation Proteinuria for Cardiovascular Outcomes in Kidney Transplant Recipients. H. Jeon,1 J. Hwang,1 H. Kim,3 S. Park,3 K. Joo,1 C. Lim,2 Y. Oh,2 C. Ahn,1 Y. Kim,1 J. Lee.2 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Republic of; 2Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea, Republic of; 3Department of Internal Medicine, Ulsan University College of Medicine, Seoul, Korea, Republic of. Background: Proteinuria has been shown to be associated with mortality, progression to kidney failure, and cardiovascular disease events in general population. Herein, we have analyzed the effect of proteinuria on cardiovascular outcomes, graft loss, and mortality in kidney transplant recipients (KTRs). Methods: We performed a retrospective multi-center study to evaluate the effect of post-transplantation proteinuria on cardiovascular outcomes, graft loss, and patients’ survival. This study enrolled a total of 2052 KTRs in Seoul National University Hospital and Asan Medical Center, and patients were classifi ed into three groups according to the amount of proteinuria (<150mg/day [group 1] vs. 150-1500mg/day [group 2] vs. >1500mg/day [group 3]). The primary endpoint was major adverse cardiac events (MACE), defi ned as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Results: The mean age of the recipients was 43.6 ± 11.4 years, and 58.6% were male. During a median 55.3-month follow-up, there were 38 (1.9%) cases of MACE, 71 (3.5%) graft loss, and 44 (2.1%) deaths. In a Cox model adjusted with multiple covariates, proteinuria was signifi cantly associated with MACE (group 1 [reference] vs. group 2 [HR 3.29, CI 1.02-10.60, P = 0.046] vs. group 3 [HR 5.81, CI 1.2826.31, P = 0.022]). KTRs with higher proteinuria showed signifi cantly higher graft loss rate than those without proteinuria (group 1 [reference] vs. group 3 [HR 3.97, CI 1.65-9.56, P = 0.002]). However, there was no signifi cant association between proteinuria and all-cause mortality. KTRs with proteinuria showed a greater number of acute rejection episodes (10.5% [group 1] vs. 20.5% [group 2] vs. 37.1% [group 3], P < 0.001) Conclusion: Post-transplantation proteinuria is a strong prognostic factor for cardiovascular outcomes among KTRs. Therefore, evaluation and management of proteinuria should be considered to improve graft and patients outcomes. Abstract# C1739 NGAL as an Early Predictor of Delayed Graft Function. J. Nieto, L. Serna, G. Zuluaga, C. Ocampo, A. Aristizabal, C. Velez, J. Vanegas, A. Bedoya, S. Lopera, N. Giraldo. Hospital Pablo Tobon Uribe, Medellin, Colombia. C1739 NGAL as an Early Predictor of Delayed Graft Function. J. Nieto, L. Serna, G. Zuluaga, C. Ocampo, A. Aristizabal, C. Velez, J. Vanegas, A. Bedoya, S. Lopera, N. Giraldo. Hospital Pablo Tobon Uribe, Medellin, Colombia. Delayed graft function (DGF) occurs in 20-50% of renal transplants and is a complication that can affect graft survival. The creatinine reduction ratio (CRR) has been the gold standard for defi ning DGF. Urinary neutrophil gelatinase-associated lipocalin (NGALu) is an early marker of acute kidney injury. The aims of this study were to describe the behavior of NGALu in deceased-donor renal transplant recipients and to compare this indicator with the CRR for the early detection of DGF. Methodology:This was a prospective cohort study, in which NGALu levels were assessed at 1, 12, 24 and 48 hours after renal transplantation and compared with the daily CRR. Descriptive statistics and nonparametric tests were performed. The best cutoff points and the optimal assessment times for both markers were explored; a comparison of the receiver operating characteristic (ROC) curves for the NGALu level and the CRR was carried out to diagnose DGF.Results:Sixty-one patients were included in the study, 54.8% male and 91.9% fi rst transplant recipients, with a median age of 36.5 years and a median cold ischemia time of 15 hours. DGF occurred in 12 patients and 4 patients required dialysis in the fi rst week. NGALu levels at all the cut-off points were higher in patients with DGF (p=0.49, p=0.0321, p=0.0421 and p=0.0035, respectively). NGALu>120 ng/ml at 48 hours predicted DGF with a sensitivity of 75% and specifi city of 67.8%. A CRR of 59% best discriminated DGF, with a sensitivity of 91 % and specifi city of 83% at 48 hours. In comparing the ROC curves for the NGALu level and the CRR, the CRR was a better marker.