Date: Monday, June 13, 2016
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Ballroom C
Background Deceased-donor kidneys with acute kidney injury (AKI) are often discarded for fear of poor transplantation outcomes. Donor biomarkers that predict post-transplant renal recovery could improve organ selection and reduce discard. We tested whether higher levels of donor urinary YKL-40, a repair phase protein, were associated with improved recipient outcomes.
Methods We conducted a prospective cohort study involving deceased kidney donors from five organ procurement organizations (OPOs). We measured urinary YKL-40 concentration in 1301 donors (111 had AKI, defined as doubling of serum creatinine) and ascertained outcomes in the corresponding 2435 recipients, 756 of whom experienced delayed graft function (DGF).
Results YKL-40 was higher among donors with AKI (p<0.0001), and there was a stepwise relationship between increasing YKL-40 levels and worsening acute tubular necrosis severity on procurement biopsies (p=0.0483), suggesting YKL-40 is produced in response to tubular injury. In fully adjusted analyses, elevated donor urinary YKL-40 was associated with reduced risk of DGF in both recipients of AKI donor kidneys (adjusted relative risk 0.51 [0.32-0.80] for highest versus lowest YKL-40 tertile) and non-AKI donor kidneys (adjusted relative risk 0.79 [0.65-0.97]). Furthermore, in the event of DGF, elevated donor urinary YKL-40 was associated with higher 6-month eGFR (6.75 [1.49, 12.02] mL/min/1.73m2) and lower risk of graft failure (adjusted hazard ratio 0.50 [0.27, 0.94]).
Conclusions: Donor urinary YKL-40 is associated with recovery from AKI and DGF and, if ultimately validated as a prognostic biomarker, should be considered to determine suitability of injured donor kidneys for transplantation. These findings, taken in the context of preclinical studies, demonstrate the role of YKL-40 expression in cytoprotection and renal repair.
CITATION INFORMATION: Puthumana J, Hall I, Reese P, Schröppel B, Weng F, Thiessen-Philbrook H, Doshi M, Rao V, Lee C, Elias J, Cantley L, Parikh C. YKL-40 Predicts Renal Recovery in Deceased-Donor Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Puthumana J, Hall I, Reese P, Schröppel B, Weng F, Thiessen-Philbrook H, Doshi M, Rao V, Lee C, Elias J, Cantley L, Parikh C. YKL-40 Predicts Renal Recovery in Deceased-Donor Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/ykl-40-predicts-renal-recovery-in-deceased-donor-transplantation/. Accessed January 26, 2020.
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