The fluid in which a donor kidney is transported to the recipient patient contains proteins that enable physicians to predict whether or not the kidney will function soon and effectively after the transplant. This week, researchers headed by the University Medical Center (UMC) Utrecht will be publishing the results in the Clinical Journal of the American Society of Nephrology. "This is a first step on the road towards shorter waiting lists," say UMC Utrecht internist-nephrologist Dr. Arjan van Zuilen and researcher Dr. Bas van Balkom.

Van Balkom, researcher at the Nephrology and Hypertension explains: “Our research demonstrates for the first time that we can use biomarkers (proteins) from transport fluid to determine the quality of a donor kidney.”
Van Zuilen adds: “This technique enables us to determine whether the kidney will work before it is implanted. Thus far this was only possible after the kidney had been transplanted. The period after the transplant is now still very stressing for the recipient due to the complex procedure and the uncertainty about how the kidney will function. Using the new research results, we can prevent complications and dismiss the patient earlier.

Two proteins

After being harvested, the donor kidneys secrete proteins (such as cytokines and growth factors) into the preservation fluid during transport to the transplant center. In a study designed to identify predictive factors (biomarkers) for the quality of donor kidneys, the UMC Utrecht and the Erasmus MC (Rotterdam) measured 158 different proteins in this preservation fluid. The researchers discovered that a combination of two proteins, leptin and GM-CSF (Granulocyte-Macrophage Colony Stimulating Factor), forms a good predictor of whether the donor kidney transplant will readily be accepted by the recipient.

Follow-up research

Before this technique can be applied on a large scale, follow-up research will have to be carried out to enable researchers to confirm the predictive value of biomarkers. If the result is successful, Van Balkom and Van Zuilen expect that the use of this non-invasive and relatively straightforward method can lead to a better functioning of the transplanted kidneys and larger numbers of successful transplants. "We hope we will also be able to use the biomarkers to determine whether kidneys that we otherwise would have to reject may be successful in certain patients," Van Balkom adds.

Donor shortage

In the event of serious renal failure, a kidney transplant is the best option. However, due to a shortage of donors, kidneys of less healthy donors are often used. Physicians assess in advance, particularly on the basis of the kidney's appearance and the donor's and recipient's characteristics, whether the kidney will work well after the transplant. Sometimes a biopsy specimen – a small piece of kidney tissue – is taken for this purpose. However, these methods only have a limited predictive value and/or may even damage the kidney.

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Dr. Bas van Balkom
 

Dr. Arjan van Zuilen

Publications

Balkom BWM van, Gremmels H, Ooms LSS, Toorop RJ, Dor FJMF, Jong OG de, Michielsen LA, Borst GJ de, Jager W de, Abrahams AC, Zuilen AD van, Verhaar MC. Proteins in preservation fluid as predictors of delayed graft function in kidneys from donors after circulatory death. Clinical Journal of the American Society of Nephrology, 2017 doi:10.2215/CJN.10701016
 
Hall IE. Can preservation fluid biomarkers predict delayed graft function in transplanted kidneys? Clinical Journal of the American Society of Nephrology, 2017 doi:10.2215/CJN.03250317