Kidney Week

Abstract: FR-PO1191

Donor Plasma IGFBP-7 Is Associated with Post-Transplant Kidney Function and Graft Survival

Session Information

• Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Fawaz, Sarah, University of Oxford, Oxford, England, United Kingdom

Sarah Fawaz, PhD

• Michelakis, Ioannis, University of Oxford, Oxford, United Kingdom

Ioannis Michelakis, MD, MSc

• Vaughan`, Rebecca, University of Oxford, Oxford, England, United Kingdom

Rebecca Vaughan`, PhD

• Kollias, Dimitrios, Queen Mary University of London, London, England, United Kingdom

Dimitrios Kollias

• Kaisar, Maria, University of Oxford, Oxford, England, United Kingdom

Maria Kaisar, PhD

Background

Current donor kidney assessment relies largely on demographics and static functional variables and incompletely captures biological organ injury. IGFBP-7 is a circulating mediator of cellular senescence that may reflect donor kidney injury prior to transplantation

Methods

Donor plasma IGFBP-7 was measured in 848 deceased donors from the QUOD biobank, linked to 1,691 kidney transplant recipients. Associations with post-transplant eGFR were assessed using covariate-adjusted regression, first adjusting for donor clinical factors (Model 1), then additionally for recipient clinical factors (Model 2). Death-censored graft survival was analysed using Kaplan–Meier and Cox regression.

Results

Higher IGFBP-7 independently associated with lower eGFR at 12 months (β=−12 ml/min per log₁₀ increase, p<0.001), persisting to 36 months and remaining robust after Model 1 and Model 2 adjustments (Fig 1A). In paired-kidney donor-level analysis, IGFBP-7 was the highest where both kidneys functioned poorly (eGFR ≤30; median 15,851 pg/mL) and lowest where both functioned well (eGFR ≥45; median 13,022 pg/mL; p<0.001; Fig 1B), supporting a donor-intrinsic biological signal. Adjusted cox regression demonstrated a significant association between IGFBP-7 levels and death-censored graft failure in DBD donors, but not DCD donors, with an adjusted HR of 2.54 in DBD donors (95% CI1.29–4.99, p=0.007)

Conclusion

Donor plasma IGFBP-7 independently associates with poorer post-transplant function and long-term graft survival, with its prognostic signal most pronounced in DBD donors. The paired-kidney analysis provides compelling evidence of a donor-level biological contribution. These findings support prospective evaluation of IGFBP-7 as a tool for biological risk stratification of deceased donor kidneys at the point of allocation.

Acknowledgment

Quality of organ donors (QUOD) biobank
Kidney Research UK (KRUK)
NHS Blood and Transplant Registry

Donor plasma IGFBP-7 associates with post-transplant eGFR and paired-kidney outcomes. (A) Association with recipient eGFR at 12 and 36 months. (B) IGFBP-7 by paired kidney outcome: both poor (eGFR ≤30, PNF, or graft loss ≤1 year), both moderate (eGFR 31–44), or both good (eGFR ≥45).

Funding

• Clinical Revenue Support