The Value of Machine Perfusion Biomarker Concentration in DCD Kidney Transplantations

Abstract

Donation after cardiac death (DCD) increases the number of donor kidneys but is associated with more primary non-function (PNF) and delayed graft function (DGF). It has been suggested that biomarkers in the preservation solution of machine perfused kidneys may predict PNF although evidence is lacking. We analyzed the diagnostic accuracy of the perfusate biomarkers GST, LDH and H-FABP to predict PNF and DGF in 335 DCD kidneys, preserved by hypothermic machine perfusion at our center between 1 January 1997 and 1 January 2008. The diagnostic accuracy of these biomarkers to predict PNF, DGF and long-term graft survival were evaluated with the area under the receiver operator characteristics curves (AURC). LDH concentration was associated with PNF (OR 1.001, 95%CI 1.000-1.002, p=0.005); the diagnostic accuracy for PNF was poor for GST, LDH and H-FABP concentrations (AURC 0.58, 0.63 and 0.56, respectively). Adjustment for perfusate flow did not improve diagnostic accuracy. LDH concentration was associated with DGF, biomarker concentration was not associated with 1-year graft survival. The diagnostic accuracy of the perfusate biomarkers LDH, GST, H-FABP to predict viability of DCD kidneys is poor. Therefore, DCD kidneys should not be discarded because of high biomarker perfusate concentration.