Abstract
IntroductionExpanding the criteria for deceased organ donors increases the risk of delayed graft function (DGF) and complicates kidney transplant outcome. We studied whether donor neutrophil gelatinase-associated lipocalin (NGAL), a novel biomarker for acute kidney injury, could predict DGF after transplantation.MethodsWe included 99 consecutive, deceased donors and their 176 kidney recipients. For NGAL detection, donor serum and urine samples were collected before the donor operation. The samples were analyzed using a commercial enzyme-linked immunosorbent assay kit (serum) and the ARCHITECT method (urine).ResultsMean donor serum NGAL (S-NGAL) concentration was 218 ng/mL (range 27 to 658, standard deviation (SD) 145.1) and mean donor urine NGAL (U-NGAL) concentration was 18 ng/mL (range 0 to 177, SD 27.1). Donor S-NGAL and U-NGAL concentrations correlated directly with donor plasma creatinine levels and indirectly with estimated glomerular filtration rate (eGFR) calculated using the modification of diet in renal disease equation for glomerular filtration rate. In transplantations with high (greater than the mean) donor U-NGAL concentrations, prolonged DGF lasting longer than 14 days occurred more often than in transplantations with low (less than the mean) U-NGAL concentration (23% vs. 11%, P = 0.028), and 1-year graft survival was worse (90.3% vs. 97.4%, P = 0.048). High U-NGAL concentration was also associated with significantly more histological changes in the donor kidney biopsies than the low U-NGAL concentration. In a multivariate analysis, U-NGAL, expanded criteria donor status and eGFR emerged as independent risk factors for prolonged DGF. U-NGAL concentration failed to predict DGF on the basis of receiver operating characteristic curve analysis.ConclusionsThis first report on S-NGAL and U-NGAL levels in deceased donors shows that donor U-NGAL, but not donor S-NGAL, measurements give added value when evaluating the suitability of a potential deceased kidney donor.
Highlights
Expanding the criteria for deceased organ donors increases the risk of delayed graft function (DGF) and complicates kidney transplant outcome
We recently found that recipient urine neutrophil gelatinase-associated lipocalin (NGAL) (U-NGAL) measured the first morning following transplantation predicted DGF, in cases where early graft function (EGF) was expected on the basis of diuresis and decreasing plasma creatinine concentration [27]
Using the high vs. low NGAL division, we found that mean donor plasma creatinine level was significantly higher and that mean estimated glomerular filtration rate (eGFR) was lower in the high NGAL groups compared to the low NGAL groups (Table 3)
Summary
Expanding the criteria for deceased organ donors increases the risk of delayed graft function (DGF) and complicates kidney transplant outcome. Deceased kidney donors are expected to have healthy kidneys which will function well in the recipient after transplantation. A considerable number of kidney transplantations from deceased donors are complicated by delayed graft function (DGF). Various algorithms have been designed for the evaluation of deceased donors [8,9,10]. As these scoring systems use recipient and transplantation variables such as cold ischemia time and human leukocyte antigen (HLA) matching, they cannot be used when deciding whether to accept or reject the donor. The judgment relies on the only readily available markers: diuresis and plasma creatinine level
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