Kidney Week

Abstract: SA-PO1083

Angiopoietins and Delayed Graft Function in Kidney Transplant Recipients

Session Information

• Transplantation: Clinical - Postkidney Transplant Outcomes and Potpourri
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Berry, Shivankshi, Yale School of Medicine, New Haven, Connecticut, United States

Shivankshi Berry, MBBS

• Turco, David, Yale School of Medicine, New Haven, Connecticut, United States

David Turco, MD

• Moore, Kareen, Yale School of Medicine, New Haven, Connecticut, United States

Kareen Moore, MD

• Qian, Long, Yale School of Medicine, New Haven, Connecticut, United States

Long Qian, MD

• Faulkner, Sophia, Yale School of Medicine, New Haven, Connecticut, United States

Sophia Faulkner

• Hall, Isaac E., University of Utah Health, Salt Lake City, Utah, United States

Isaac E. Hall, MD, MS

• Obeid, Wassim, Johns Hopkins University, Baltimore, Maryland, United States

Wassim Obeid, PhD

• Thiessen Philbrook, Heather, Johns Hopkins University, Baltimore, Maryland, United States

Heather Thiessen Philbrook

• Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States

Chirag R. Parikh, MD, PhD, FASN

• Mansour, Sherry, Yale School of Medicine, New Haven, Connecticut, United States

Sherry Mansour, MD, MS

Background

Delayed graft function (DGF) is increasing with greater use of high-risk donors. Early identification of patients at risk and better phenotyping are key for post-transplant management. Vascular biomarkers like angiopoietin-1 (Angpt-1) and angiopoietin-2 (Angpt-2) may aid in risk stratification and post-transplant discharge planning.

Methods

In an ancillary study of a prospectively enrolled cohort of deceased donor kidney transplant recipients, we measured Angpt-1 and Angpt-2 in plasma from 67 patients. Biomarkers were assessed over the first 3 days post-transplant days with the first sample collected soon after
arriving to the ICU after transplant. Day 2 levels—where group differences were most pronounced—were used to evaluate associations with DGF and number of dialysis sessions in the first 7 days. Multivariable logistic and Poisson regression models were adjusted for donor/recipient age, sex, race, donor/recipient hypertension, recipient diabetes, and day 2 creatinine.

Results

A total of 26 recipients experienced DGF, requiring between 1 and 5 inpatient dialysis sessions. While both Angpt-1 and Angpt-2 levels declined after transplant, this decline occurred more gradually in patients with DGF. Angpt-1 was not associated with DGF or number of dialysis sessions. Angpt-2 measurement on the first post-operative day was independently associated with DGF (adjusted OR: 6.34, 95% CI: 1.57–25.65) and dialysis frequency (adjusted RR: 3.77,95% CI: 1.77–8.03). When added to the clinical model, AUC 0.75 (95%CI -.62-0.89), Angpt-2 improved the AUC to 0.81 (95% CI: 0.70–0.92) and yielded a net reclassification index of 0.23 for events and 0.51 for non-events.

Conclusion

Slower Angpt-2 decline in recipients with DGF suggests ongoing vascular injury and impaired repair. Angpt-2 shows promise as a biomarker for DGF risk and severity, improving prediction beyond clinical variables. These findings support further study of Angpt-2 in post-transplant risk stratification and care planning.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20257efh1qqg