title: The value of machine perfusion biomarker concentration in DCD kidney transplantations.
abstract: BACKGROUND
  Donation after cardiac death (DCD) increases the number of donor kidneys but is associated with more primary nonfunction (PNF) and delayed graft function (DGF). It has been suggested that biomarkers in the preservation solution of machine perfused kidneys may predict PNF, although evidence is lacking.
  
  
  METHODS
  We analyzed the diagnostic accuracy of the perfusate biomarkers glutathione S-transferase, lactate dehydrogenase (LDH), heart-type fatty acid binding protein, redox-active iron, interleukin (IL)-18, and neutrophil gelatinase-associated lipocalin to predict PNF and DGF in 335 DCD kidneys preserved by hypothermic machine perfusion at our center between 1 January 1997 and 1 January 2008. The diagnostic accuracy of these biomarkers to predict PNF was evaluated with the area under the receiver operating characteristics curves. Additionally, the risk of DGF and graft failure was assessed.
  
  
  RESULTS
  LDH and IL-18 concentrations were associated with PNF (odds ratio [95% confidence interval], 1.001 [1.000-1.002]; P=0.005 and 1.001 [1.000-1.002]; P=0.003, respectively) in a multivariate analysis; the diagnostic accuracy for PNF was "poor" for all biomarkers but increased to "fair" for redox-active iron and IL-18 in a multivariate analysis (area under the receiver operating characteristics curves, 0.701 and 0.700, respectively). LDH and IL-18 concentrations were associated with DGF; biomarker concentration was not associated with 1-year graft survival.
  
  
  CONCLUSIONS
  The diagnostic accuracy of the perfusate biomarkers glutathione S-transferase, LDH, heart-type fatty acid binding protein, redox-active iron, IL-18, and neutrophil gelatinase-associated lipocalin to predict viability of DCD kidneys varies from "poor" to "fair". Therefore, DCD kidneys should not be discarded because of high biomarker perfusate concentration.
authors.affiliation: Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. p.hoogland@mumc.nl
authors.forename: E R Pieter
authors.initials: ER
authors.lastname: Hoogland
authors.forename: Eva E
authors.initials: EE
authors.lastname: de Vries
authors.forename: Maarten H L
authors.initials: MH
authors.lastname: Christiaans
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Maarten G J
authors.initials: MG
authors.lastname: Snoeijs
authors.forename: L W Ernest
authors.initials: LW
authors.lastname: van Heurn
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D051799:Delayed Graft Function / Q000209:etiology / Q000378:metabolism; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000032:analysis; D005260:Female; D005982:Glutathione Transferase / Q000032:analysis; D006085:Graft Survival; D006801:Humans; D020382:Interleukin-18 / Q000032:analysis; D007501:Iron / Q000032:analysis; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D000071068:Lipocalin-2; D054834:Lipocalins / Q000032:analysis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy; D016017:Odds Ratio; D009926:Organ Preservation / Q000009:adverse effects / Q000379:methods*; D019188:Organ Preservation Solutions / Q000737:chemistry*; D010084:Oxidation-Reduction; D010477:Perfusion / Q000009:adverse effects; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011518:Proto-Oncogene Proteins / Q000032:analysis; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D019188:Organ Preservation Solutions; D011518:Proto-Oncogene Proteins; D007501:Iron; D007770:L-Lactate Dehydrogenase; D005982:Glutathione Transferase