Introduction: Extended criteria deceased kidneys are associated with prolonged delayed graft function and worse patient survival. Therefore it is important to identify factors in marginal donors that affect kidney quality and function. We validated a reported donor scoring system from donation after brain death (DBD) donors in a cohort of circulatory death (DCD) transplant recipients. In addition, we related marginal donor scores, protocol biopsy characteristics and fractional NGAL excretion (FeNGAL) to duration of functionally defined delayed graft function (f-DGF) and one-year renal function (eGFR). Methods: 92 consecutive DCD transplant recipients were included, all receiving IL2-RB induction and triple maintenance therapy (CNI, steroids, MMF). Day-10 protocol biopsies were scored according to the Banff criteria and ATN characteristics. In addition, NGAL was stained and %-surface positivity quantified with image-J. Day-10 FeNGAL was calculated using serum and urinary NGAL. Statistical analysis included uni- and multivariable binary logistic regression and ROC curves. Results: In DCD recipients the previously reported marginal donor scoring system was also associated with impaired one-year GFR (p<0.0005) and duration of f-DGF (p=0.002). Multivariable analysis identified donor age, f-DGF, and mismatch degree (2DR or 1DR/2B) as independent risk factors for inferior one-year GFR. In ROC analysis this model predicted GFR ≤40ml/min with an AUC of 0.87 (0.76-0.98). In histology only IF/TA scores and denudation were associated with impaired one-year GFR, increasing the AUC from 0.87 to 0.94 (0.88-1.00). In the analysis of patients with moderate (8-20 days) and severe (≥21 days) f-DGF only IF/TA score remained an independent predictor for severe f-DGF. Although NGAL staining did not discriminate these groups, day-10 FeNGAL tended to differentiate between moderate and severe f-DGF (p=0.064). Moreover FeNGAL and duration of f-DGF were strongly correlated (R=0.91). Conclusion: Also in DCD recipients a high clinical donor score was associated with inferior one-year renal function. The most important predictor for prolonged f-DGF was IF/TA. In addition, sequential fractional NGAL excretions may serve as a non-invasive marker to guide management in patients with marginal donor kidneys and delayed function.

« Back to 2015 American Transplant Congress