P3766 - Serum Cystatin C Is Better Predictor of Renal Dysfunction Among African American Patients Undergoing Liver Transplant Evaluation

Anjana Mary Jacob, APRN¹, Jeff Angelo Taclob, MD², Satheesh Nair, MD³
1Methodist University, Lakeland, TN; 2University of Tennessee Health Science Center - Methodist University Hospital, Lubbock, TX; 3Methodist LeBonheur Healthcare, Memphis, TN

Introduction: In patients with portal hypertension and sarcopenia due to End Stage Liver Disease (ESLD), accurate assessment of renal function is critical for management of volume status and for prognosis models such as MELD score. While Serum Cystatin C (normal range 0.6-1.2 mg/dl) is a more reliable determinant of GFR than serum Creatinine, it is not known whether it is useful among African American patients with ESLD. This study aims to explore the predictive value of Cystatin C among African Americans (AA) undergoing liver transplant evaluation.

Methods: Cystatin C was measured in all consecutive patients undergoing Liver Transplant Evaluation and we studied serum creatinine (SCr), serum cystatin C (CysC), MELD 3.0 and MELD Cystatin C (MELD Cy). MELD Cy was obtained by substituting the value of CysC for creatinine in the MELD 3.0 calculation. We compared the MELD 3.0, MELD Cy, SCr based GFR (CKD EPI) and eGFR (CKD EPI) based on SCr and CysC for AA. A cohort of Caucasian patients who underwent liver transplant evaluation at the same period were used as control. Paired t-test was used to compare the eGFR and MELD scores.

Results: Records of 90 patients (20 AA and 70 Caucasians) with ESLD were accessed. Demographic data and renal parameters are summarized in the table and figure. Among both AA and Caucasians, the CysC was higher compared to SCr measured on the same day reflecting the value of CysC in assessing renal dysfunction in patients with ESLD and loss of muscle mass in both ethnicities. Mean SCr and CysC among Caucasians were 1.01mg/dl (+/- 0.44) and 1.78 (+/- 0.67) and among AA were 1.302 mg/dl (+/-1.81) and 1.71 (+/-0.82), respectively. Similarly, eGFR based on SCr with CysC was significantly lower than eGFR based on SCr in both ethnicities (57.1 ± 21.2; 81.9 ± 26.9; p-value < 0.005 for Caucasians, 60 ± 22.9; 78.7 ± 29; p-value 0.03 for African Americans). However, MELD Cy resulted only in a modest increase from MELD 3.0 in AA (21.25+/- 6.8; 19.1 +/- 6.5; p value 0.328) compared to Caucasians (22.4 +/- 6.7; 18.6+/- 5.8; p value < 0.005).

Discussion: CysC is a more accurate predictor of renal dysfunction in both AA and Caucasians with decompensated Cirrhosis. While MELD Cy offers gains in MELD score models, in both ethnicities, impact of MELD Cy is higher among Caucasians compared to AA. Future prognostic models in ESLD should incorporate Cystatin C instead of Serum creatinine.


Figure: Figure: Demographics.


Figure: Table: MELD 3.0, MELD Cy, S. Creatinine, S. Cystatin C and eGFR among African Americans versus Caucasians.

Disclosures:
Anjana Mary Jacob indicated no relevant financial relationships.
Jeff Angelo Taclob indicated no relevant financial relationships.
Satheesh Nair indicated no relevant financial relationships.

Anjana Mary Jacob, APRN¹, Jeff Angelo Taclob, MD², Satheesh Nair, MD³. P3766 - Serum Cystatin C Is Better Predictor of Renal Dysfunction Among African American Patients Undergoing Liver Transplant Evaluation, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.