Intra-individual variation of cystatin C and creatinine in pediatric solid organ transplant recipients

Pediatr Transplant. 2005 Feb;9(1):28-32. doi: 10.1111/j.1399-3046.2005.00235.x.


There is controversy about the feasibility of cystatin C (CysC) as a marker of glomerular filtration rate (GFR) post-transplant (Tx). We studied intra-patient variability of CysC in comparison with serum creatinine (SCr) in 20 children (11 males, mean age 11.5 +/- 6.4 yr) with solid organ transplants (14 kidney, four liver, and two combined liver + kidney transplants). The mean age at Tx was 7.0 +/- 5.6 yr. A total of 178 simultaneous SCr and CysC measurements (median 8 per patient) were analyzed. In addition, GFR was calculated using the Schwartz and a novel CysC-based formula. Intra-individual coefficient of variations (CV) was calculated as ratio of standard deviation over mean. The mean CV was significantly lower for SCr (7.71 +/- 4.16%) when compared with CysC (10.27 +/- 4.87, p = 0.04), but was no longer significantly different when excluding patients with a bladder augment. The CV of the GFR estimated by Schwartz formula (7.44 +/- 3.77) was significantly lower than GFR calculated from CysC (12.52 +/- 7.37), p = 0.001. The mean ratio between the Schwartz GFR and the GFR calculated from CysC was 102.6 +/- 12.8%, not significantly different from 100% (p = 0.3796). The only potential confounding factors to explain increased CV after Tx were gender and bladder augmentation, whereas calcineurin inhibitors or steroids did not influence CV. With the limitation of a small number of subjects, our data suggest that the CysC and the CysC-calculated GFR is equivalent but not better than SCr and Schwartz formula. We therefore conclude that measurement of CysC can be used for longitudinal intra-individual follow-up of renal function post-Tx.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Creatinine / blood*
  • Cystatin C
  • Cystatins / metabolism*
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney Function Tests
  • Kidney Transplantation*
  • Liver Transplantation*
  • Male
  • Retrospective Studies
  • Time Factors


  • CST3 protein, human
  • Cystatin C
  • Cystatins
  • Immunosuppressive Agents
  • Creatinine