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Updated: May 10, 2026
17:13
Non-invasive Imaging of Acute Allograft Rejection after Rat Renal Transplantation Using 18F-FDG PET
Published on: April 28, 2013
Urinary NGAL Outperforms 99mTc-MAG3 Renography in Predicting DCD Kidney Graft Function
Esther N M de Rooij1,2, Tirsa T van Duijl3, Ellen K Hoogeveen1,2,4
1Department of Nephrology, Leiden University Medical Center, Leiden, Netherlands.
Summary
Urinary neutrophil gelatinase-associated lipocalin (NGAL) and its fractional excretion (FE-NGAL) can predict delayed graft function (DGF) in kidney transplant recipients. These biomarkers show promise as alternatives to traditional renography for monitoring DGF.
Area of Science:
- Nephrology and Transplant Surgery
- Biomarker Discovery and Validation
- Ischemia-Reperfusion Injury Research
Background:
- Donation after circulatory death (DCD) kidney recipients face high risks of delayed graft function (DGF) due to ischemia-reperfusion injury.
- Accurate prediction and monitoring of DGF are crucial for optimizing transplant outcomes.
- Current monitoring methods like tubular function slope (TFS) using 99mTc-MAG3 renography have limitations.
Purpose of the Study:
- To compare the predictive performance of urinary biomarkers for DGF duration against the gold standard TFS in DCD kidney transplant recipients.
- To evaluate novel urinary biomarkers, including NGAL and FE-NGAL, for their ability to predict DGF severity and progression.
Main Methods:
- Quantification of urinary TIMP-2, IGFBP7, B2M, NGAL, KIM1, CXCL9, and UMOD via LC-MS/MS in 89 DCD kidney transplant recipients at postoperative days (PODs) 1, 4, and 10.
- Assessment of interstitial fibrosis and tubular atrophy (IF/TA) using protocol biopsies at POD 10.
- Calculation of TFS using 99mTc-MAG3 renography and comparison of predictive performance using ROC analyses.
Main Results:
- Urinary NGAL and FE-NGAL at POD 4 demonstrated superior predictive performance for DGF compared to TFS and other biomarkers (AUCs 0.97 and 0.98, respectively).
- At POD 10, FE-NGAL and PCR best predicted severe versus mild to moderate DGF (AUCs 0.74 and 0.76), outperforming TFS (AUC 0.65).
- A significant association was found between IF/TA and DGF severity, with higher odds for severe DGF (OR 15.0).
Conclusions:
- Urinary NGAL and FE-NGAL are promising non-invasive biomarkers for predicting and monitoring DGF in DCD kidney transplant recipients.
- These biomarkers may serve as a viable alternative to 99mTc-MAG3 renography for assessing DGF clearance.
- NGAL and FE-NGAL could guide decisions for kidney transplant biopsies, potentially excluding additional acute rejection.
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