Abstract: TH-PO1034
Cumulative Lactate Dehydrogenase Burden Above Normal and Long-Term Allograft Outcomes in Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Erman, Orit, Sheba Medical Center, Tel HaShomer, Tel Aviv District, Israel
- Vaisman, Adva, Sheba Medical Center, Tel HaShomer, Tel Aviv District, Israel
- Beckerman, Pazit, Sheba Medical Center, Tel HaShomer, Tel Aviv District, Israel
Background
Lactate dehydrogenase (LDH) reflects cellular injury but has not been evaluated as a chronic graft biomarker in kidney transplantation. We examined whether cumulative LDH burden predicts long term allograft dysfunction.
Methods
Single center retrospective cohort of 591 adult kidney transplant recipients. To avoid confounding by early postoperative events, data collection commenced 3 months post transplantation. Patients with hepatic disease, hemolysis, or active malignancy were excluded. LDH area under the curve (AUC) above 260 U/L was calculated using corrected trapezoidal integration and stratified into quintiles (Q1–Q5). The primary outcome was a composite of ≥40% eGFR decline from baseline or end stage kidney disease, analyzed as time to event. Secondary outcomes were rapid eGFR decline (slope ≤−3 mL/min/1.73 m^2/year) and continuous eGFR slope. Cox, logistic, and linear models adjusted for age, sex, cardiovascular disease, hypertension, diabetes, heart failure, and tacrolimus time in range.
Results
Mean age was 55.5±13.7 years; 30.6% were women, 71.7% had hypertension, and 39.6% had diabetes. Median follow up was 4.0 years; the primary composite occurred in 99 patients (16.8%). Composite event rates rose from 6.7% in Q1 to 24.6% in Q4–Q5, showing a trend, albeit nonsignificant, across LDH quintiles (log rank p=0.08). LDH AUC was significantly associated with kidney function loss: each log unit increase was linked to ~1.2 mL/min/1.73 m^2/year faster eGFR decline (p=0.013). Adding LDH quintile to an adjusted model improved discrimination for rapid eGFR decline (AUC ROC 0.667 to 0.694; ΔAUC 0.027, p=0.042) and nearly doubled adjusted risk in Q4–Q5 versus Q1–Q3 (32% vs 17%; Figure 1).
Conclusion
Cumulative LDH burden above the upper normal limit is significantly associated with faster eGFR loss and modestly improves identification of patients at risk for rapid allograft deterioration beyond established risk factors. LDH warrants evaluation as a simple, routinely available biomarker for long term graft monitoring.
Acknowledgment
AI assisted analyses used Claude; authors retain responsibility