Deceased kidney donor cystatin C and subsequent recipient kidney function one year after transplantation
Belle Dielwart1,2, Daan Kremer2, Tim J Knobbe2, Dion Groothof2, Henri G.D. Leuvenink1, Jenny E Kootstra-Ros3, Martin H de Borst2, Marco van Londen2, Jan-Stephan F Sanders2, Robert A Pol2, Stephan J.L. Bakker3.
1Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; 2Internal Medicine, division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; 3Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
Background: Deceased donor kidney selection is largely determined by creatinine-based kidney function estimation. However, muscle wasting is common in potential donors and affects the accuracy of creatinine-based kidney function assessment. The aim of this study was to evaluate the associations of donor creatinine-based and cystatin C-based kidney function estimations with recipient kidney function one year after transplantation.
Methods: Using data from the prospective TransplantLines study, multivariable linear regression analyses were performed to examine the associations of donor plasma creatinine and cystatin C as well as the corresponding estimated GFR equations with recipient kidney function (I125-iothalamate measured glomerular filtration rate (mGFR) or 24-h creatinine clearance).
Results: Donor plasma cystatin C and creatinine data were available for 96 donor-recipient pairs. Median pre-donation creatinine and cystatin C concentrations were 56.0 [49.5-71.0] µmol/L and 0.63 [0.50-0.82] mg/L, respectively. Recipient mGFR and 24h-creatinine clearance were 52.1±17.0 ml/min and 57.7±24.0 ml/min, respectively. Donor plasma cystatin C was significantly associated with recipient mGFR (st. β -0.52 [-0.83 to -0.21], p=0.002) and 24-h creatinine clearance (st. β -0.42 [-0.62 to -0.22], p<0.001), while creatinine was not (mGFR: st. β -0.19 [-0.48 to 0.10], p=0.21 and 24-h creatinine clearance: st. β -0.21 [-0.45 to -0.02], p=0.08). The association of cystatin C and recipient outcomes remained materially unchanged after adjustment for potential confounders.
Conclusion: In kidney donors, plasma cystatin C was independently associated with recipient kidney function, while creatinine was not. Using cystatin C can therefore improve the accuracy of deceased donor kidney selection.
This publication is part of DKTSG (Dutch Kidney Transplant Study Group) project. The funders had no role in the study design, data collection, analysis, reporting, or decision to submit for publication. . This publication is part of the ADORABLE (Artificial intelligence-powered, Data-driven ORgan Allocation and Biomarker LEverage to improve kidney transplant outcomes) project with file number KICH2.V4P.NN23.002 of the research programme KIC-One kidney for life, which is (partly) financed by the Dutch Research Council (NWO). The funders had no role in the study design, data collection, analysis, reporting, or the decision to submit for publication. .
[1] Biomarker
[2] Cystatin C
[3] Donor screening