Kidney Week

Abstract: TH-PO0994

Donor Plasma Adiponectin Identifies Biological Heterogeneity in Diabetic Donor Kidney Transplantation

Session Information

• Transplantation: Basic - Immune Biology, Tissue Injury, and Emerging Technologies
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2001 Transplantation: Basic

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

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

Maria Kaisar, PhD

Background

Diabetic donor kidneys are considered higher risk, yet outcomes are heterogeneous and not fully explained by diabetes status alone. Adiponectin is a renoprotective adipokine consistently suppressed in diabetes, making it a plausible marker of metabolic organ injury. FABP4, an adipocyte fatty acid-binding protein upregulated in adipose dysfunction, was co-measured to characterise the broader metabolic injury profile and assess signal specificity.

Methods

Plasma adiponectin and FABP4 were measured in 225 deceased kidney donors from the QUOD Biobank (75 diabetic, 150 non-diabetic matched controls), linked to 450 recipients. Primary outcome was 12-month eGFR, adjusted for donor age, DCD status, recipient age and cold ischaemia time. Graft survival was assessed by Kaplan–Meier and Cox regression, with median adiponectin (7.6 µg/mL) used as the threshold.

Results

Higher donor adiponectin independently associated with better 12-month eGFR (β=+13.9 mL/min per log₁₀ unit, p=0.017), with a stronger signal in diabetic donors (β=+20.0, p=0.019) and DBD diabetic donors specifically (β=+29.5, p=0.007; Fig 1A). Stratification by median adiponectin revealed markedly distinct graft survival: loss 37% vs 18% in low vs high groups (p=0.013; Fig 1B), confirmed by donor age adjusted Cox regression (HR=0.67, 95% CI 0.49–0.93, p=0.012). FABP4 showed no independent association with eGFR or graft survival, supporting specificity of the adiponectin signal.

Conclusion

Donor plasma adiponectin identifies clinically meaningful heterogeneity within diabetic deceased donors. These findings suggest that diabetes status alone is insufficient to characterise donor kidney quality and support further investigation of adiponectin as a candidate biological marker in this high-risk donor group.

Acknowledgment

QUOD biobank
Kidney Research UK (KRUK)
NHS Blood and Transplant (NHSBT)
Oxford Transplant Foundation (OTF)

Figure 1: Multivariable associations between donor plasma adiponectin and recipient outcomes (n=225 donors, 450 recipients). 1A: Adjusted β coefficients (mL/min/1.73m² per log₁₀ unit) for 12-month eGFR across three progressively focused models. 1B: death-censored graft survival in diabetic donors stratified by median plasma adiponectin (7.6 µg/ml); Cox model adjusted for donor age.

Funding

• Government Support – Non-U.S.