Introduction: Delayed graft function is a common complication after deceased donor kidney transplantation (KT), which affects both short and long-term outcome. Currently available biomarkers in perfusate lack sensitivity in predicting graft outcome. The aim of this study is to reveal microRNA profiles in preservation fluid of kidney grafts that correlate with graft outcome.

Methods: In this study, perfusate samples were collected during kidney transplantations from both living and deceased donors. The graft outcome was defined as immediate graft function (IF) and delayed graft function (DGF). As a discovery cohort 9 IF samples and 9 DGF samples were analysed for six known kidney miRNAs selected from the literature. As validation cohort, we analysed 10 living donor samples with IF, 10 deceased donor samples with IF and 10 deceased donor samples with DGF and tested two miRNAs that gave most promising results during the discovery stage.

Results: All baseline characteristics of the groups were comparable except for cold ischemia time, 152 minutes in the IF group vs. 798 minutes in DGF group, P <0.001. Levels of miR-199, -194, -192 and -182 were mostly undetectable. However, levels of miR-21 and miR-155 were significantly different between the IF and DGF groups. Mean level of miR-21 was 52 in IF group versus 8 in DGF group, P= 0.005. Mean level miR-155 in the IF group was 16 and 1 in the DGF group, P= 0.026. In the validation cohort, the mean level of miR-21 for living donor samples with IF was 59, and 12 in the deceased donor group with IF and in the deceased donor group with DGF the miR-21 level was 0.2, P< 0.001. Mean level of miR-155 was not significantly different in de three groups.

Conclusion: MiRNAs in graft preservation fluids are promising novel biomarkers for predicting outcome prior to kidney transplantation. In the era of extended criteria donor organs, this may have great clinical impact for graft reconditioning strategies to improve transplant outcome.

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