Role of novel biomarkers in kidney transplantation

Table 6 Summary of biomarkers associated with graft quality

Ref.	n	Sample	Biomarkers	Outcome	Study conclusion
Parikh et al[46], 2016	671	Perfusate	NGAL, L-FABP	6 mo eGFR	Each doubling of perfusate NGAL and L-FABP were independently associated with ↓6-month eGFR (1.7mL/min per 1.73m2; 1.48mL/min per 1.73m2 )
Moser et al[47], 2017	41	Perfusate	MMP-2, LDH, NGAL	Biomarker levels	MMP-2a,b, LDHa,b, and NGALa,b were found in highest perfusate concentrations in DCD kidneys, followed by DBD and living donor allografts
Hamaoui et al[48], 2017	10	Perfusate	Perfusate lactate	Perfusion	10 DCD porcine kidneys perfused via HMP with modified AL solutionc had significantly ↓ perfusion lactate levels (3.1 vs 4.1 mmol/L) during reperfusion than those in UW solution
van Smaalen et al[49], 2017	390	Perfusate	Extracellular histone concentration	1 yr graft survival	(extracellular histone) was associated w/ 1 year graft failure (HR = 1.386) 1 year graft survival was ↑ for the ↓ extracellular histone groupd (83% vs 71%) , maintained up to 5 yearse (76% vs 65%)
Weissenbacher et al[50], 2019	11	Perfusate	NGAL, KIM-1	Kidney quality	↑ perfusate NGAL level was found in the lowest quality kidney. In the perfused kidneys w/o urine recirculation, NGAL and KIM-1 ↓ over time. Small sample size; NGAL/ KIM-1 not predictive of kidney quality
Hosgood et al[53], 2017	56	Urine	NGAL, endothelin-1	Kidney quality per EVKP score	↑ levels of NGAL and ET-1 were associated with ↑ EVKP scoref (P < 0.05)

^aP < 0.0001 vs Donation after brain death kidneys.

^bP < 0.0001 vs living donor kidneys.

^cP < 0.05 vs Deceased cardiac death donor kidneys perfused with University of Wisconsin solution.

^dP < 0.01 vs increased extracellular histone group.

^eP < 0.05 vs increased extracellular histone group.

^fP < 0.05 vs EVKP group A. NGAL: Neutrophil gelatinase-associated lipocalin; L-FABP: Liver fatty acid binding protein; eGFR: Estimated glomerular filtration rate; MMP-2: Matrix metalloproteinase-2 LDH: Lactate dehydrogenase; DBD: Donation after brain death; DCD: Deceased cardiac death donor; HMP: Hypothermic machine perfusion; AL: Adenosine lidocaine; UW: University of Wisconsin; HR: Hazard ratio; KIM-1: Kidney injury molecule-1; EVKP: Ex vivo normothermic kidney perfusion; ET-1: Endothelin-1.