Department of Statistics and Clinical Research, NHS Blood and Transplant, Bristol, UK.
School of Immunology and Microbial Sciences, King's College London, London, UK.
Nephrol Dial Transplant. 2022 Oct 19;37(11):2275-2283. doi: 10.1093/ndt/gfac250.
Urinalysis is a standard component of potential deceased kidney donor assessment in the UK. The value of albuminuria as a biomarker for organ quality is uncertain. We examined the relationship between deceased donor albuminuria and kidney utilization, survival and function.
We performed a national cohort study on adult deceased donors and kidney transplant recipients between 2016 and 2020, using data from the UK Transplant Registry. We examined the influence of donor albuminuria, defined as ≥2+ on dipstick testing, on kidney utilization, early graft function, graft failure and estimated glomerular filtration rate (eGFR).
Eighteen percent (1681/9309) of consented donors had albuminuria. After adjustment for confounders, kidneys from donors with albuminuria were less likely to be accepted for transplantation (74% versus 82%; odds ratio 0.70, 95% confidence interval 0.61 to 0.81). Of 9834 kidney transplants included in our study, 1550 (16%) came from donors with albuminuria. After a median follow-up of 2 years, 8% (118/1550) and 9% (706/8284) of transplants from donors with and without albuminuria failed, respectively. There was no association between donor albuminuria and graft failure (hazard ratio 0.91, 95% confidence interval 0.74 to 1.11). There was also no association with delayed graft function, patient survival or eGFR at 1 or 3 years.
Our study suggests reluctance in the UK to utilize kidneys from deceased donors with dipstick albuminuria but no evidence of an association with graft survival or function. This may represent a potential to expand organ utilization without negatively impacting transplant outcomes.
尿液分析是英国潜在已故肾脏供体评估的标准组成部分。白蛋白尿作为器官质量生物标志物的价值尚不确定。我们研究了已故供体白蛋白尿与器官利用、生存和功能之间的关系。
我们使用英国移植登记处的数据，对 2016 年至 2020 年间的成年已故供体和肾移植受者进行了全国队列研究。我们研究了供体白蛋白尿（定义为试纸检测≥2+）对肾脏利用、早期移植物功能、移植物失功和估算肾小球滤过率（eGFR）的影响。
18%（1681/9309）的同意供体有白蛋白尿。在调整混杂因素后，白蛋白尿供体的肾脏更不可能被接受移植（74%对 82%；优势比 0.70，95%置信区间 0.61 至 0.81）。在我们的研究中包括的 9834 例肾移植中，1550 例（16%）来自有白蛋白尿的供体。中位随访 2 年后，白蛋白尿供体和无白蛋白尿供体的移植分别有 8%（118/1550）和 9%（706/8284）失功。供体白蛋白尿与移植物失功之间没有关联（风险比 0.91，95%置信区间 0.74 至 1.11）。与延迟移植物功能、患者生存或 1 年或 3 年时的 eGFR 也没有关联。
我们的研究表明，英国不愿意利用有试纸白蛋白尿的已故供体的肾脏，但没有证据表明与移植物生存或功能有关。这可能代表着在不影响移植结果的情况下扩大器官利用的潜力。
