Associations of Perfusate Biomarkers and Pump Parameters With Delayed Graft Function and Deceased Donor Kidney Allograft Function

作者：Parikh C R^*; Hall I E; Bhangoo R S; Ficek J; Abt P L; Thiessen Philbrook H; Lin H; Bimali M; Murray P T; Rao V; Schroeppel B; Doshi M D; Weng F L; Reese P P

来源：American Journal of Transplantation, 2016, 16(5): 1526-1539.

DOI：10.1111/ajt.13655

Hypothermic machine perfusion (HMP) is increasingly used in deceased donor kidney transplantation, but controversy exists regarding the value of perfusion biomarkers and pump parameters for assessing organ quality. We prospectively determined associations between perfusate biomarkers (neutrophil gelatinase-associated lipocalin [NGAL], kidney injury molecule 1, IL-18 and liver-type fatty acid-binding protein [L-FABP]) and pump parameters (resistance and flow) with outcomes of delayed graft DGF) and 6-mo estimated GFR (eGFR). DGF occurred in 230 of 671 (34%) recipients. Only 1-h flow was inversely associated with DGF. Higher NGAL or L-FABP concentrations and increased resistance were inversely associated with 6-mo eGFR, whereas higher flow was associated with higher adjusted 6-mo eGFR. Discarded kidneys had consistently higher median resistance and lower median flow than transplanted kidneys, but median perfusate biomarker concentrations were either lower or not significantly different in discarded compared with transplanted kidneys. Notably, most recipients of transplanted kidneys with isolated undesirable biomarker levels or HMP parameters experienced acceptable 6-mo allograft function, suggesting these characteristics should not be used in isolation for discard decisions. Additional studies must confirm the utility of combining HMP measurements with other characteristics to assess kidney quality.
This prospective cohort study of deceased donor kidney transplant recipients whose allografts underwent hypothermic machine perfusion finds an association of the greater perfusate flow on pump with lower rates of delayed graft function, while greater perfusate flow and lower concentrations of perfusate NGAL and L-FABP measured at the end of pumping are associated with better allograft function by 6 months after transplantation.

• 出版日期2016-5