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Am J Transplant. 2016 May;16(5):1526-39. doi: 10.1111/ajt.13655. Epub 2016 Feb 17.

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

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Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT.
Section of Nephrology, Yale University School of Medicine, New Haven, CT.
Veterans Affairs Connecticut Healthcare System, West Haven, CT.
University of Arizona College of Medicine, Phoenix, AZ.
Department of Surgery, University of Pennsylvania, Philadelphia, PA.
Department of Medicine, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
Mount Sinai School of Medicine, New York, NY.
University Hospital, Ulm, Germany.
Wayne State University, Detroit, MI.
Barnabas Health, Livingston, NJ.
Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA.
Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA.
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.


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 function (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.

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