Urine Injury Biomarkers Are Not Associated With Kidney Transplant Failure.
Publication/Presentation Date
6-1-2020
Abstract
BACKGROUND: Kidneys transplanted from deceased donors with serum creatinine-defined acute kidney injury (AKI) have similar allograft survival as non-AKI kidneys but are discarded at a higher rate. Urine injury biomarkers are sensitive markers of structural kidney damage and may more accurately predict graft outcomes.
METHODS: In the 2010-2013 multicenter Deceased Donor Study of 2430 kidney transplant recipients from 1298 donors, we assessed the association of donor urine injury biomarkers microalbumin, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, IL-18, and liver-type fatty acid binding protein with graft failure (GF) and death-censored GF (dcGF) using Cox proportional hazard models (median follow-up 4 y). We examined if serum creatinine-defined donor AKI modified this association to assess the relationship between subclinical donor AKI (elevated biomarkers without creatinine-defined AKI) and GF. Through chart review of a subcohort (1137 recipients), we determined associations between donor injury biomarkers and a 3-year composite outcome of GF, mortality, or estimated glomerular filtration rate ≤ 20mL/min/1.73m.
RESULTS: Risk of GF, dcGF, and 3-year composite outcome did not vary with donor injury biomarker concentrations after adjusting for donor, transplant, and recipient characteristics (adjusted hazard ratio ranged from 0.96 to 1.01 per log-2 increase in biomarker). Subclinical injury in transplanted kidneys without AKI was not associated with GF.
CONCLUSIONS: AKI measured using injury biomarkers was not associated with posttransplant graft outcomes (at median 4 y posttransplant). When assessing posttransplant graft viability, clinicians can prioritize other donor and recipient factors over donor kidney injury, measured by either serum creatinine or urine injury biomarkers.
Volume
104
Issue
6
First Page
1272
Last Page
1279
ISSN
1534-6080
Published In/Presented At
Koyawala, N., Reese, P. P., Hall, I. E., Jia, Y., Thiessen-Philbrook, H. R., Mansour, S. G., Doshi, M. D., Akalin, E., Bromberg, J. S., Harhay, M. N., Mohan, S., Muthukumar, T., Schröppel, B., Singh, P., Weng, F. L., & Parikh, C. R. (2020). Urine Injury Biomarkers Are Not Associated With Kidney Transplant Failure. Transplantation, 104(6), 1272–1279. https://doi.org/10.1097/TP.0000000000002948
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
31568213
Department(s)
Administration and Leadership
Document Type
Article