Donor Urinary Biomarkers and the Prediction of Deceased Donor Allograft Function.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 42424130.
- Also identified by DOI 10.1681/ASN.0000001183.
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Abstract
Kidney transplant allocation currently relies on the Kidney Donor Profile Index (KDPI), a measure which has limitations. This study evaluated the potential of using KDPI and deceased donor urinary biomarkers to improve the assessment of organ quality and the prediction of allograft outcomes compared with KDPI alone. Pairs of kidney recipients from the same donor transplanted between 2010 and 2013 were followed for 3 years post-transplant from kidneys procured at five OPOs. By 3 years post transplant, concordant good outcomes were defined as both recipients having an estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73m2, while concordant poor outcomes were defined as both recipients experiencing graft failure (return to dialysis or waitlisted) or having an eGFR <20 mL/min/1.73m. Urinary biomarkers (uromodulin (UMOD), osteopontin (OPN), and chitinase-3-like protein 1 (YKL-40)) were measured by immunoassay using a MesoScale Device (MSD) in all donors, and by lateral flow devices in a subset. Discriminatory ability was quantified with the area under the receiver operator characteristics curve (AUC). We identified 474 donors with both kidneys transplanted and either concordant good outcomes (438; 92%) or concordant poor outcomes (36, 8%). For distinguishing concordant good from concordant poor outcomes, the AUC for KDPI alone was 0.80 (SE 0.04); the AUC for KDPI combined with UMOD, OPN, and YKL-40 measured by immunoassay was 0.86 (SE 0.03). In a subset of 105 donors with lateral flow device measurements, the AUC for KDPI plus three biomarkers was 0.85 (SE 0.04), compared with 0.81 (SE 0.05) for KDPI alone. Combining donor urinary biomarkers with KDPI improves prediction of concordant allograft outcomes, regardless of assay platform. Lateral flow device measurements can be obtained at the point-of-care and may provide additional insight into expected deceased donor allograft function, potentially aiding the kidney transplant allocation process.