title: Urinary biomarkers of acute kidney injury in deceased organ donors--kidney injury molecule-1 as an adjunct to predicting outcome.
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.
authors.affiliation: Department of Renal Transplantation, University Hospital Birmingham Foundation Trust, Birmingham, UK; MRC Centre for Immune Regulation, School of Immunity and Infection, Medical School, University of Birmingham, Birmingham, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Field
authors.forename: Vamsi
authors.initials: V
authors.lastname: Dronavalli
authors.forename: Punam
authors.initials: P
authors.lastname: Mistry
authors.forename: Mark
authors.initials: M
authors.lastname: Drayson
authors.forename: Andrew
authors.initials: A
authors.lastname: Ready
authors.forename: Mark
authors.initials: M
authors.lastname: Cobbold
authors.forename: Nicholas
authors.initials: N
authors.lastname: Inston
mesh_terms: D058186:Acute Kidney Injury / Q000652:urine*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000652:urine*; D002102:Cadaver; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine*; D008875:Middle Aged; D011379:Prognosis; D011991:Receptors, Virus; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D015415:Biomarkers; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D008562:Membrane Glycoproteins; D011991:Receptors, Virus
keywords: Kidney Injury Molecule-1; Transplantation; biomarkers; deceased organ donor