الفهرس 
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Abstract
The aim of the present work was to study the value of urinary Neutrophil Gelatinase-Associated Lipocalin (u-NGAL) as an early predictor for occurrence of Acute Kidney Injury (AKI) in patients undergoing liver transplantation in comparison with serum creatinine and RIFLE classification. To achieve this aim we studied 30 hepatic patients underwent liver transplantation in the National Liver Institute, Menoufiya University, Egypt, in the period from June 2012 to May 2014. Patients were subjected to thorough history taking, clinical examination and preoperative routine investigations, and baseline renal functions including assessment of GFR by renal isotopic scan. All patients had done live donor liver transplantation after proper cross-matching between donor and recipients. During the anhepatic phase of the operation no portocaval anastmosis was done. Operative data were collected during the operation, and the patient were assessed 5 days postoperatively for the occurrence of acute kidney injury (AKI) by the conventional methods (serume creatinine, urine output and RIFLE classification of AKI) and u-NGAL levels. Results demonstrated that: 14 patients out of 30 (46.7%) had fulfilled the criteria of RIFLE classification and had AKI. In these patients there was a significant relation between RIFLE classification and: • The cause of liver transplantation (P<0.001). 57.1% of patients of RIFLE +ve patients have HCC while (42.9%) have cirrhosis. Preoperative platelet count in both adult and pediatric patients. • Serum bilirubin level especially in pediatric patients (mean=16.9±7 mg/dL) (p=0.048). • Prothrombin conc. especially in adults (mean=48±7.5%) (p=0.026) • The use of basiliximab in the induction of immunosuppression decrease the risk of AKI post-LT (p=0.01). • Operative duration, estimated blood loss and amount of fresh frozen plasma transfusion. • Day 1, day2 u-NGAL as in day1, the mean u-NGAL in the RIFLE +ve patients was (4158.6±3426.9 pg/ml) (P 0.028), and in day2 the mean u-NGAL in the RIFLE +ve patients was (6785.7±4104.9 pg/ml) (P 0.029) In these patients u-NGAL levels above the cut-off value (1300 pg/ml) at day1 and (4440 pg/ml) at day2 have 66.7 % and 73.3% accuracy, 71.4% and 71.4% sensitivity, 62.5% and 71.4% positive predictive value respectively for prediction of AKI post-LT. also it is significantly correlated with: • Body weight (r=0.04) (P 0.02). • Presence of diabetes (P<0.001) • Preoperative platelet count (r= -0.45) (P 0.03). • Total bilirubin (r= 0.38)(P 0.03) in day1 and(r= 0.34)(P 0.04) in day2 • Intraoperative plasma transfusion (r= -0.42) (P 0.02). There was a significant difference between the mean value of u-NGAL and different causes of liver transplantation espicially in patients with HCC and portal vein thrombosis.