title: Deceased-donor kidney perfusate and urine biomarkers for kidney allograft outcomes: a systematic review.
abstract: BACKGROUND
  Accurate and reliable assessment of kidney quality before transplantation is needed to predict recipient outcomes and to optimize management and allocation of the allograft. The aim of this study was to systematically review the published literature on biomarkers in two mediums (the perfusate from deceased-donor kidneys receiving machine perfusion and deceased-donor urine) that were evaluated for their possible association with outcomes after kidney transplantation.
  
  
  METHODS
  We searched the Ovid Medline and Scopus databases using broad keywords related to deceased-donor biomarkers in kidney transplantation (limited to humans and the English language). Studies were included if they involved deceased-donor kidneys, measured perfusate or urine biomarkers and studied a possible relationship between biomarker concentrations and kidney allograft outcomes. Each included article was assessed for methodological quality.
  
  
  RESULTS
  Of 1430 abstracts screened, 29 studies met the inclusion criteria. Of these, 23 were studies of perfusate (16 biomarkers examined) and 6 were studies of urine (18 biomarkers examined). Only 3 studies (two perfusate) met the criteria of 'good' quality and only 12 were published since 2000. Perfusate lactate dehydrogenase, glutathione-S-transferase (GST) and aspartate transaminase were all found to be significantly associated with delayed graft function in a majority of their respective studies (6/9, 4/6 and 2/2 studies, respectively). Urine neutrophil gelatinase-associated lipocalin, GST, Trolox-equivalent antioxidant capacity and kidney injury molecule-1 were found to be significantly associated with allograft outcomes in single studies that examined diverse end points.
  
  
  CONCLUSIONS
  Higher quality studies are needed to investigate modern kidney injury biomarkers, to validate novel biomarkers in larger donor populations and to determine the incremental predictive value of biomarkers over traditional clinical variables.
authors.affiliation: Section of Nephrology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Ronik S
authors.initials: RS
authors.lastname: Bhangoo
authors.forename: Isaac E
authors.initials: IE
authors.lastname: Hall
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis / Q000652:urine; D015415:Biomarkers / Q000652:urine*; D002102:Cadaver; D051799:Delayed Graft Function / Q000209:etiology / Q000652:urine; D005982:Glutathione Transferase / Q000032:analysis / Q000652:urine; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016030:Kidney Transplantation / Q000009:adverse effects / Q000502:physiology*; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D019344:Lactic Acid / Q000652:urine; D000071068:Lipocalin-2; D054834:Lipocalins / Q000032:analysis / Q000652:urine; D010477:Perfusion; D011237:Predictive Value of Tests; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000032:analysis / Q000652:urine; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D019344:Lactic Acid; D007770:L-Lactate Dehydrogenase; D005982:Glutathione Transferase