Urinary NGAL Outperforms 99mTc-MAG3 Renography in Predicting DCD Kidney Graft Function

Urinary NGAL Outperforms 99mTc-MAG3 Renography in Predicting DCD Kidney Graft Function

Recipients of donation after circulatory death (DCD) kidneys are at high risk for delayed graft function (DGF) due to severe ischemia-reperfusion injury. We compared urinary biomarkers in predicting the duration of DGF with the tubular function slope (TFS) as the gold standard. In 89 DCD kidney tran...

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Main Authors: Esther N. M. de Rooij, Tirsa T. van Duijl, Ellen K. Hoogeveen, Fred P. H. T. M. Romijn, Friedo W. Dekker, Cees van Kooten, Christa M. Cobbaert, Johan W. de Fijter
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Transplant International
Subjects:
DCD donation
NGAL
urinary biomarkers
delayed graft function (DGF)
kidney transplantation
Online Access:https://www.frontierspartnerships.org/articles/10.3389/ti.2025.13818/full
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Summary:Recipients of donation after circulatory death (DCD) kidneys are at high risk for delayed graft function (DGF) due to severe ischemia-reperfusion injury. We compared urinary biomarkers in predicting the duration of DGF with the tubular function slope (TFS) as the gold standard. In 89 DCD kidney transplant recipients, urinary TIMP-2, IGFBP7, B2M, NGAL, KIM1, CXCL9, and UMOD were quantified by LC-MS/MS analysis on postoperative days (PODs) 1, 4 and 10. Interstitial fibrosis and tubular atrophy (IF/TA) were assessed with protocol biopsies at POD 10. TFS was calculated with 99mTc-MAG3 renography. Predictive performance was compared with AUCs from ROC analyses. Of all 89 recipients, 22% experienced no (<7), 22% mild (≥7–14), 29% moderate (≥14-<21) and 26% severe (≥21 days) fDGF. The OR for the presence of IF/TA was 1.9 (95% CI:0.4; 10.0) for mild to moderate and 15.0 (95% CI:2.7; 84.8) for severe compared to no fDGF. At POD 4, urinary NGAL and fractional NGAL excretion (FE-NGAL) outperformed TFS and other biomarkers in predicting fDGF with AUCs of 0.97, 0.98 and 0.92, respectively. At POD10, FE-NGAL and PCR best predicted severe vs. mild to moderate fDGF, with AUCs of 0.74 and 0.76 versus 0.65 for TFS. Therefore, urinary NGAL and FE-NGAL may provide a viable alternative to 99mTcMAG3 renography for monitoring fDGF clearance or guiding kidney transplant biopsy to exclude additional acute rejection.
ISSN:1432-2277

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