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J Am Soc Nephrol. 2016 May;27(5):1534-43. doi: 10.1681/ASN.2015040345. Epub 2015 Sep 15.

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

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Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, Department of Biostatistics and Epidemiology, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania;
Program of Applied Translational Research, Department of Medicine and Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut;
Saint Barnabas Medical Center, Livingston, New Jersey;
Section of Nephrology, University Hospital, Ulm, Germany;
Wayne State University, Detroit, Michigan;
Gift of Life Institute, Philadelphia, Pennsylvania;
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada;
School of Medicine & Medical Science, University College Dublin, Dublin, Ireland; and.
Program of Applied Translational Research, Department of Medicine and Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut


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 function (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 function (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.


acute renal failure; cadaver organ transplantation; delayed graft function

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