Deceased Kidney Donor Biomarkers: Relationship between Delayed Kidney Function and Graft Function Three Years after...

Area of Science:

• Nephrology
• Transplant Immunology
• Biomarker Discovery

Background:

• Increasing use of marginal deceased donors necessitates improved methods for assessing kidney quality.
• Current methods for evaluating donor kidney viability have limitations.

Purpose of the Study:

• To evaluate pretransplant donor serum and urine biomarkers for predicting early and late kidney allograft function.
• To compare the predictive performance of biomarkers against traditional serum creatinine levels.

Main Methods:

• Analysis of serum and urine biomarkers including NGAL, KIM-1, IL-18, and CXCL10 in 43 deceased donors.
• Correlation of biomarker levels with early (delayed graft function) and late graft function (eGFR).
• Development of a predictive model for DGF incorporating biomarkers and clinical factors.

Main Results:

• Delayed graft function (DGF) occurred in 27.6% of kidney transplants.
• Serum IL-18, serum KIM-1, urine NGAL, and urine KIM-1 were significant predictors of DGF.
• A model combining sIL-18, uKIM-1, and clinical factors achieved an AUROC of 0.863 for DGF prediction.
• Higher pretransplant urine and serum NGAL levels correlated with better allograft function at 1 and 3 years post-transplant.

Conclusions:

• Donor serum and urine biomarkers demonstrate superior performance in predicting DGF and later graft function compared to serum creatinine.
• Elevated donor sIL-18 and uKIM-1 levels, alongside expanded criteria donor status and longer cold ischemia times, predicted DGF.
• Pretransplant NGAL levels are associated with improved long-term allograft function.