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Kidney Week

Abstract: PO2192

Diagnosis of Early Delayed Graft Function (DGF) Using TIMP-2*IGFPB-7 Product in Transplant Recipients: Preliminary Results

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Leong, Russell, Beaumont Health, Royal Oak, Michigan, United States
  • Rodd, Cassandra, Beaumont Health, Royal Oak, Michigan, United States
  • Gomes, Kellyann Maria, Beaumont Health, Royal Oak, Michigan, United States
  • Savedchuk, Solomiia, Beaumont Health, Royal Oak, Michigan, United States
  • Kellerman, Paul S., Beaumont Health, Royal Oak, Michigan, United States
Background

DGF is acute kidney injury (AKI) defined as need for dialysis within one week of renal transplant. AKI is defined by a change in serum creatinine (SCr), however early recognition is limited by delay in creatinine rise. Accurate early biomarkers may lead to prevention or treatment of established AKI. The product of two novel biomarkers of cell cycle arrest, tissue Inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IGFBP-7) have shown promise in predicting AKI. In prior studies, TIMP-2*IGFPB-7 <0.3 had high negative predictive value, and >2 high positive predictive value for AKI. Aims - 1) Investigate the early diagnostic value of TIMP-2*IGFPB-7 for DGF; 2) Correlate TIMP-2*IGFPB-7 with long term graft function.

Methods

This is a prospective, double-blinded single center observational study with goal enrollment of 150 transplant recipients. Urine TIMP-2*IGFBP-7 was measured in (ng/mL)2/1000 with a commercial kit, Nephrocheck (Astute Medical, San Diego, CA) at 4-12 hours, 48-72 hours and 72-96 hours post-transplant. SCr was measured just prior to transplant, 1 week post-transplant, and at 1, 3, 6, 9 and 12 months post-transplant.

Results

Thus far, 64 patient samples have been collected, 11 with DGF. Mean TIMP-2*IGFPB-7 were 3.08 + 0.63 vs 0.54 + 0.23 (p-value <0.001) at 4-12 hours, 3.39 + 0.93 vs 0.38 + 0.13 at 24-48 hours (p-value <0.001), and 1.73 + 0.76 vs 0.62 + 0.27 (p-value =0.09) at 72-96 hours in DGF vs non DGF patients respectively. Mean SCr at 1 week were 6.14 + 0.71 mg/dL in DGF vs 2.13 + 0.26 mg/dL (p-value <0.001) in non-DGF. Correlation between peak TIMP-2*IGFPB-7 at 24-48 hours and sCr at 1, 3, 6, 9, and 12 months, was nonsignificant.

Conclusion

These preliminary results confirm the use of TIMP-2*IGFBP product measured by Nephrocheck in the diagnosis and prediction of DGF in the post-kidney transplant period as early as 4-12 hours, and peaking at 24-48 hours. The non-DGF TIMP-2*IGFBP-7 means were higher than prior reports, suggesting mild renal injury in the peritransplant period in those patients without DGF. The current sample size is too small and underpowered as of yet to draw conclusions on prediction of long-term renal dysfunction.

Funding

  • Commercial Support