*Purpose: Neutrophil gelatinase-associated lipocalin (NGAL) has recently emerged as a biomarker of different conditions, but the biological role remains unclear. We hypnotized that NGAL has also immunomodulatory effect that may affects organs outcome of kidney transplant recipients.

*Methods: Kidneys (n=23) from donations after circulatory death and neurological death were perfused with machine cold perfusion. NGAL on perfusates was quantified. We correlated NGAL levels on perfusates with clinical outcomes of perfused kidney transplant recipients. In vitro experiments, we tested the effect of NGAL on collected PBMC from healthy donors.

*Results: NGAL was detected on perfusates (18.65±2.1pg/dl). Based on median value, we defined two groups: Low NGAL and High NGAL. Recipients receiving kidney with higher production of NGAL during cold perfusion resulted in significative better eGFR at 1 week after transplantation (p<0.05) (Fig 1A). The same trend was significatively maintained for the first year after kidney transplant (p<0.01) (Fig 2A). Moreover, delays graft function was associated with lower NGAL levels (Fig 3A). In in vitro experiments, NGAL up-regulated expansion of T-regulatory cells in healthy donors (Fig 4A).

*Conclusions: NGAL levels on perfusate is positive correlated with renal transplant function, both in early and delayed phases after kidney transplantation. Together with our published and confirmed evidences that EPO promotes human Treg expansion and HLA-G expression (PLoS One 2014), the data support a new possible tolerogenic role of NGAL.

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