Postoperative day 1 serum cystatin C level predicts postoperative delayed graft function after kidney transplantation

Yajuan Li; Bo Wang; Le Wang; Kewei Shi; Wangcheng Zhao; Sai Gao; Jiayu Chen; Chenguang Ding; Junkai Du; Wei Gao

doi:10.3389/fmed.2022.863962

Postoperative day 1 serum cystatin C level predicts postoperative delayed graft function after kidney transplantation

Front Med (Lausanne). 2022 Aug 12:9:863962. doi: 10.3389/fmed.2022.863962. eCollection 2022.

Authors

Yajuan Li^{1

2}, Bo Wang¹, Le Wang¹, Kewei Shi¹, Wangcheng Zhao¹, Sai Gao¹, Jiayu Chen¹, Chenguang Ding³, Junkai Du⁴, Wei Gao¹

Affiliations

¹ Department of Anesthesiology and Center for Brain Science and Center for Translational Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
² Department of Anesthesiology, 521 Hospital of Norinco Group, Xi'an, China.
³ Department of Renal Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
⁴ Department of Emergency, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Abstract

Background: Delayed graft function (DGF) commonly occurs after kidney transplantation, but no clinical predictors for guiding post-transplant management are available.

Materials and methods: Data including demographics, surgery, anesthesia, postoperative day 1 serum cystatin C (S-CysC) level, kidney functions, and postoperative complications in 603 kidney transplant recipients who met the enrollment criteria from January 2017 to December 2018 were collected and analyzed to form the Intention-To-Treat (ITT) set. All perioperative data were screened using the least absolute shrinkage and selection operator. The discrimination, calibration, and clinical effectiveness of the predictor were verified with area under curve (AUC), calibration plot, clinical decision curve, and impact curve. The predictor was trained in Per-Protocol set, validated in the ITT set, and its stability was further tested in the bootstrap resample data.

Result: Patients with DGF had significantly higher postoperative day 1 S-CysC level (4.2 ± 1.2 vs. 2.8 ± 0.9 mg/L; P < 0.001), serum creatinine level (821.1 ± 301.7 vs. 554.3 ± 223.2 μmol/L; P < 0.001) and dialysis postoperative (74 [82.2%] vs. 25 [5.9%]; P < 0.001) compared with patients without DGF. Among 41 potential predictors, S-CysC was the most effective in the parsimonious model, and its diagnostic cut-off value was 3.80 mg/L with the risk score (OR, 13.45; 95% CI, 8.02-22.57; P < 0.001). Its specificity and sensitivity indicated by AUC was 0.832 (95% CI, 0.779-0.884; P < 0.001) with well fit calibration. S-CysC yielded up to 50% of clinical benefit rate with 1:4 of cost/benefit ratio.

Conclusion: The postoperative day 1 S-CysC level predicts DGF and may be used as a predictor of DGF but warrants further study.

Keywords: area under curve; clinical decision curve; delayed graft function; kidney transplantation; least absolute shrinkage and selection operator; serum cystatin C.