Urinary biomarkers of acute kidney injury in deceased organ donors - kidney injury molecule-1 as an adjunct to predicting outcome

Research output: Contribution to journalArticlepeer-review

Authors

  • Melanie Field
  • Vamsi Dronavalli
  • Andrew Ready
  • Mark Cobbold
  • Nicholas Inston

External organisations

  • MRC Centre for Immune Regulation, Institute for Microbiology and Infection, School of Immunity and Infection, Institute for Biomedical Research, Medical School; University of Birmingham; Edgbaston Birmingham UK
  • Department of Cardiothoracic Surgery; University Hospital Birmingham Foundation Trust; Birmingham UK
  • Department of Renal Transplantation; University Hospital Birmingham Foundation Trust; Birmingham UK

Abstract

Background
Deceased kidney donors are increasingly “marginal,” and many have risk factors for acute kidney injury (AKI) that may impact on subsequent renal transplant outcome. Despite this, determining the presence of AKI at the time of deceased organ donation remains difficult.

Methods
Urine samples from 182 brainstem dead multi-organ donors (all of whom donated hearts that were transplanted) were analyzed for a Luminex™ panel of biomarkers linked with AKI. This included KIM-1, NGAL, IFN-γ, TNF-α, cystatin C, Fractalkine and vascular endothelial growth factor. Levels were correlated to early renal transplant outcomes, most specifically delayed graft function.

Results
Donor urinary KIM-1 levels were significantly higher in donors whose kidneys displayed aberrant early function (p = 0.011). Fractalkine levels showed a trend toward elevation in such donors but uncorrected this did not attain significance. No correlation occurred with the remaining biomarkers.

Conclusions
KIM-1 appears to show promise as a marker for AKI in deceased cardiac organ donors. The availability of a lateral flow device (Renastick™) for KIM-1 that also demonstrates higher urinary KIM-1 levels in donors whose kidneys show aberrant initial function (p = 0.03), makes KIM-1 a potential indicator of AKI that may merit further evaluation for its application at the donor bedside.

Details

Original languageEnglish
Pages (from-to)808-815
Number of pages8
JournalClinical transplantation
Volume28
Issue number7
Early online date3 Jun 2014
Publication statusPublished - 1 Jul 2014