Delayed Graft Function: The AKI of Kidney Transplantation

Abstract

With the growing wait list of individuals waiting for kidney transplantation, there has been renewed interest in the quality and function of donor organs. In particular, concern about the development of delayed allograft function (DGF) after transplantation continues to lead to the avoidance of donor organs offered to a transplant center. DGF is associated with worse short-and long-term outcomes and associated with higher rejection rates. There are no FDA-approved therapies to mitigate the ischemic injury that occurs. Risk factors include both donor and recipient characteristics, although their prediction is not precise. With new understanding about mechanisms of injury and new focus on the function of the deceased donor, there is opportunity to identify not only novel therapies to improve allograft function but to identify potential biomarkers of DGF. DGF remains a significant factor in impacting kidney transplant outcome, and finding biomarkers will assist in the development and approval of novel agents to ameliorate early and later injury. This mini-review highlights our presentation at the 23rd International Conference on Advances in Critical Care Nephrology and UAB/UCSD O'Brien Center Acute Kidney Injury (AKI) Pre-Meeting.

Keywords: Acute renal injury; Allograft; Chemokine; Outcomes; Transplantation.

Figure 1

MCP-1 expression in BD donor serum, urine and kidney biopsies. A. Gene expression of MCP-1 in BDD kidney biopsies (n=29) was upregulated compared to normal, healthy controls (n=4), although this was not statistically significant (p=0.649). Values are fold induction compared to healthy controls, mean ± SEM. B. Representative immunohistochemical staining for MCP-1 in kidney biopsies from BDD and healthy controls (upper panels 100×, lower panels 200×). Expression was localized to tubular epithelium. C. Urine MCP-1 levels stratified by recipients with DGF (+DGF) and those without (−DGF). DGF was associated with significantly higher urine levels in BDD (*p=0.0498).