Urine Neutrophil Gelatinase-Associated Lipocalin Determination as a Donor Auxiliary Examination Method — First Results

Abstract

A growing lack of donor organs has caused extension of criteria for deceased donation. Therefore, elderly donors and donors with increased serum creatinine levels, as well as donors after cardiocirculatory death, have become used more frequently. The examination of such donors is strongly limited due to the lack of time, and the determination of the quality of donor organs is still based on clinical and laboratory screening data of donors. Implementation of new examination methods is required to determine the functional condition of donor organs more accurately, which would allow correct selection of donors. This retrospective study included all consecutive deceased donor (DD) kidney transplantations (KTx) performed in a single centre during the period from 1 January 2010 till 30 November 2011. The donor examination was supplemented by the urine neutrophil gelatinase-associated lipocalin (U-NGAL) test. Recipients were available for follow- up for at least 12 months (totally 97 KTx from 63 DD). All cases were divided into four groups according to U-NGAL and serum creatinine (S-Crea) levels in donors: group I - normal U-NGAL and S-Crea (n = 70); group II - elevated U-NGAL and S-Crea (n = 10); group III - elevated U-NGAL and normal S-Crea (n = 9); group IV - normal U-NGAL and elevated S-Crea (n = 8). Information about rates of delayed graft function (DGF) and immediate graft function (IGF), acute rejection (AR), recipient S-Crea levels during the first post-transplant year for functioning grafts, graft losses and recipient deaths were summarised. Donor urine NGAL level showed moderate correlation with donor S-creatinie level (r = 0.543, P < 0.001). DGF was observed in 20 recipients (21%) and demonstrated association with increased donor S-creatinine (0.135 ± 0.061 vs. 0.108 ± 0.04 mmol/l in IGF, p < 0.05). Combination of increased donor S-Crea and U-NGAL (group II) was associated with worse graft function during the first year after transplantation. Recipients in group III had increased S-Crea at the time of discharge from hospital and at one year after transplantation. One-year death censored graft survival and recipient survival was similar in all groups (P = NS). Determination of U-NGAL can be used as a donor auxiliary examination method for determination of the kidney graft functional condition and for prediction of post-transplant results. The study needs to be continued with a higher number of observations and longer post-transplant follow-up.