Urine Injury Biomarkers Are Not Associated with Kidney Transplant Failure

Neel Koyawala, Peter P. Reese, Isaac E. Hall, Yaqi Jia, Heather R. Thiessen-Philbrook, Sherry G. Mansour, Mona D. Doshi, Enver Akalin, Jonathan S. Bromberg, Meera N. Harhay, Sumit Mohan, Thangamani Muthukumar, Bernd Schröppel, Pooja Singh, Francis L. Weng, Chirag R. Parikh

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


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/1.73m2. 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.

Original languageEnglish
Pages (from-to)1272-1279
Number of pages8
Issue number6
StatePublished - 1 Jun 2020
Externally publishedYes


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