Associations between Deceased-Donor Urine Injury Biomarkers and Kidney Transplant Outcomes

作者：Reese Peter P; Hall Isaac E; Weng Francis L; Schroeppel Bernd; Doshi Mona D; Hasz Rick D; Thiessen Philbrook Heather; Ficek Joseph; Rao Veena; Murray Patrick; Lin Haiqun; Parikh Chirag R^*

来源：Journal of the American Society of Nephrology, 2016, 27(5): 1534-1543.

DOI：10.1681/ASN.2015040345

Assessment of deceased-donor organ quality is integral to transplant allocation practices, but tools to more precisely measure donor kidney injury and better predict outcomes are needed. In this study, we assessed associations between injury biomarkers in deceased-donor urine and the following outcomes: donor AKI (stage 2 or greater), recipient delayed graft defined as dialysis in first week post-transplant), and recipient 6-month eGFR. We measured urinary concentrations of microalbumin, neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), IL-18, and liver-type fatty acid binding protein (L-FABP) from 1304 deceased donors at organ procurement, among whom 112 (9%) had AKI. Each biomarker strongly associated with AKI in adjusted analyses. Among 2441 kidney transplant recipients, 31% experienced delayed graft function, and mean +/- SD 6-month eGFR was 55.7 +/- 23.5 ml/min per 1.73 m(2). In analyses adjusted for donor and recipient characteristics, higher donor urinary NGAL concentrations associated with recipient delayed graft highest versus lowest NGAL tertile relative risk, 1.21; 95% confidence interval, 1.02 to 1.43). Linear regression analyses of 6-month recipient renal function demonstrated that higher urinary NGAL and L-FABP concentrations associated with slightly lower 6-month eGFR only among recipients without delayed graft function. In summary, donor urine injury biomarkers strongly associate with donor AKI but provide limited value in predicting delayed graft function or early allograft function after transplant.

• 出版日期2016-5