Ma Maolin, Han Fei, Leng Qianghua, Chen Xiaorong, Tang Zuofu, Zhang Jinhua, Luo You, Zhang Yang, Huang Zhengyu, Na Ning
Organ Transplantation Research Institution, Division of Kidney Transplantation, Department of Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Front Immunol. 2025 Mar 17;16:1545280. doi: 10.3389/fimmu.2025.1545280. eCollection 2025.
Expanded criteria donors (ECD) have the potential to greatly increase the donor organ pool but pose a higher risk of delayed graft function (DGF) post-transplantation. Uridine diphosphate-glucose (UDP-Glc) plays a significant role in extracellular signaling related to tissue damage and retains stability for detection. Donor urinary UDP-Glc level may be an appropriate and effective biomarker for predicting DGF.
Recipients who underwent successful kidney transplantation, with corresponding collection of donor urine samples, between June 2023 and August 2024 were included. We measured preoperative donor urinary UDP-Glc levels and analyzed their correlation with graft recovery. The study was registered in the Clinical Trial Registry (no. NCT06707272).
Preoperative donor urinary UDP-Glc levels were different between immediated, slowed, and delayed graft function subgroups (7.23 vs. 9.04 vs. 10.13 ug/mL, 0.001). Donor urinary UDP-Glc level was an independent risk factor for DGF (odds ratio [OR] = 1.741, 95% confidence interval [CI]: 1.311-2.312, 0.001). Furthermore, donor urinary UDP-Glc showed a better predictive value for DGF (AUROC = 0.791, 95% CI: 0.707-0.875, 0.001), and combining donor urinary UDP-Glc and donor terminal serum creatinine improved the model predictive value for DGF (AUROC = 0.832, 95% CI: 0.756-0.908, Youden index = 0.56, sensitivity = 0.81, specificity = 0.75, PPV = 0.72, NPV = 0.83, 0.001). Additionally, the donor urinary UDP-Glc level was related to the recipient serum creatinine level at 1 month post-transplantation (r = 0.475, 0.001).
Donor urinary UDP-Glc level is an independent risk factor for DGF and can provide surgeons with a novel strategy to predict DGF earlier and more accurately without invasive procedures.
https://clinicaltrials.gov, NCT06707272 identifier.
扩大标准供体（ECD）有可能大幅增加供体器官库，但移植后发生移植肾功能延迟恢复（DGF）的风险更高。尿苷二磷酸葡萄糖（UDP-Glc）在与组织损伤相关的细胞外信号传导中起重要作用，且检测时稳定性良好。供体尿液UDP-Glc水平可能是预测DGF的一种合适且有效的生物标志物。
纳入2023年6月至2024年8月间成功接受肾移植且相应收集了供体尿液样本的受者。我们测量了术前供体尿液UDP-Glc水平，并分析其与移植肾功能恢复的相关性。该研究已在临床试验注册中心注册（编号：NCT06707272）。
即刻、缓慢和延迟移植肾功能亚组之间的术前供体尿液UDP-Glc水平存在差异（7.23对9.04对10.13μg/mL，P<0.001）。供体尿液UDP-Glc水平是DGF的独立危险因素（比值比[OR]=1.741，95%置信区间[CI]：1.311-2.312，P<0.001）。此外，供体尿液UDP-Glc对DGF具有较好的预测价值（曲线下面积[AUROC]=0.791，95%CI：0.707-0.875，P<0.001），将供体尿液UDP-Glc与供体终末期血清肌酐相结合可提高DGF的模型预测价值（AUROC=0.832，95%CI：0.756-0.908，约登指数=0.56，灵敏度=0.81，特异度=0.75，阳性预测值=0.72，阴性预测值=0.83，P<0.001）。此外，供体尿液UDP-Glc水平与移植后1个月时受者血清肌酐水平相关（r=0.475，P<0.001）。
供体尿液UDP-Glc水平是DGF的独立危险因素，可为外科医生提供一种无需侵入性操作即可更早、更准确预测DGF的新策略。
