AUTHOR=de Rooij Esther N. M. , van Duijl Tirsa T. , Hoogeveen Ellen K. , Romijn Fred P. H. T. M. , Dekker Friedo W. , van Kooten Cees , Cobbaert Christa M. , de Fijter Johan W. 

TITLE=Urinary NGAL Outperforms 99mTc-MAG3 Renography in Predicting DCD Kidney Graft Function

JOURNAL=Transplant International

VOLUME=Volume 38 - 2025

YEAR=2025

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2025.13818

DOI=10.3389/ti.2025.13818

ISSN=1432-2277

ABSTRACT=Recipients of DCD kidneys face high risk of DGF due to severe ischemia-reperfusion injury.We compared urinary biomarkers in predicting DGF duration to the tubular function slope (TFS) as golden standard. For 89 DCD kidney transplant recipients, urinary TIMP-2, IGFBP7, B2M, NGAL, KIM1, CXCL9 and UMOD were quantified by LC-MS/MS analysis at postoperative day (POD) 1, 4 and 10. Interstitial fibrosis and tubular atrophy (IF/TA) was assessed in day-10 protocol biopsies. TFS was calculated with 99m Tc-MAG3 renography. Predictive performance was compared AUCs from ROC analyses. Of all 89 recipients, 22% experienced no (<7), 22% mild (≥7-14), 29% moderate (≥14-<21) and 26% severe (≥21 days) fDGF. The OR for IF/TA presence was 1.9 (95%CI:0.4;10.0) for mild to moderate and 15.0 (95%CI:2.7;84.8) for severe compared to no fDGF. On POD4, urinary NGAL and fractional NGAL-excretion (FE-NGAL) outperformed TFS and other biomarkers in predicting fDGF with AUCs of 0.97, 0.98 and 0.92, respectively. On POD10, FE-NGAL and PCR predicted severe vs mild to moderate fDGF best, with AUCs 0.74 and 0.76 versus 0.65 for TFS. Hence, urinary NGAL and FE-NGAL may provide a viable alternative to 99mTcMAG3 renography for monitoring fDGF resolution or guide a kidney transplant biopsy to exclude additional acute rejection.