Date: Monday, May 4, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Assessment of organ quality is integral to allocation, yet existing tools have a limited ability to predict important transplant outcomes. We evaluated whether injury biomarkers, measured in deceased donor urine at procurement, are associated with 1) donor acute kidney injury (AKI) and 2) 6-month kidney allograft function.
Methods: In this deceased-donor cohort from 5 organizations, we measured concentrations of albumin, neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) from procurement urine samples. We defined donor AKI as ≥2-fold rise in serum creatinine (Scr) from admission to the terminal value (at least AKI stage 2). We estimated 6-month recipient glomerular filtration rate (eGFR) based on Scr reported by centers to UNOS. Biomarker values were log-transformed for normality. We fit multivariable models for the outcomes and adjusted for donor and recipient variables as appropriate. We also examined the association of biomarkers with 6-month eGFR, stratified by delayed graft function (DGF).
Results: 1301 donors yielded 2435 individual transplants. AKI occurred in 111 (9%) donors. Compared to donors without AKI, the levels of all 3 biomarkers were higher in donors with AKI [adjusted RR 2.1 (IQR 2.82, 2.44), 1.71 (1.57, 1.87) and 1.26 (1.09, 1.44) per unit increase in albumin, NGAL and KIM-1, respectively]. DGF occurred in 756 (31%) recipients and mean 6-month eGFR was 56±24 ml/min/1.73m2. In linear regression models adjusted for donor characteristics, albumin and NGAL were independently associated with 6-month recipient eGFR. Adjusted for donor and recipient characteristics, linear regression models revealed a significant interaction between these biomarkers and DGF. In recipients without DGF, 6-month eGFR was 1.5 (0.21, 2.80) or 0.7 (0.02, 1.38) ml/min/1.73m2 lower for each unit increase in donor urine albumin or NGAL, respectively. In recipients with DGF, however, there were no significant associations between these 2 biomarkers and 6-month eGFR. There were also no significant associations between donor KIM-1 and recipient 6-month eGFR.
Conclusions: Structural AKI in deceased donors, as measured by urine albumin and NGAL, is associated with modest reductions in 6-month function for allografts that do not experience DGF. Donor injury may be an important independent measure of organ quality that merits further investigation.
To cite this abstract in AMA style:Parikh C, Hall I, Doshi M, Schroppel B, Weng F, Hasz R, Murray P, Rao V, Thiessen-Philbrook H, Ficek J, Reese P. Associations Between Deceased-Donor Urine Biomarkers of Kidney Injury and 6-Month Kidney Transplant Function [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/associations-between-deceased-donor-urine-biomarkers-of-kidney-injury-and-6-month-kidney-transplant-function/. Accessed January 24, 2020.
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