Journal Article

Donor biomarkers as predictors of organ use and recipient survival after neurologically deceased donor organ transplantation

Lebovitz, Daniel J., Al-Khafaji, Ali, Wang, Shu, Li, Shengnan, Murugan, Raghavan, Kellum, John A., Souter, Michael, Stuart, Susan R.N.

2018

Overview

We sought to build prediction models for organ transplantation and recipient survival using both biomarkers and clinical information. We abstracted clinical variables from a previous randomized trial (n = 556) of donor management. In a subset of donors (n = 97), we measured two candidate biomarkers in plasma at enrollment and just prior to explantation. Secretory leukocyte protease inhibitor (SLPI) was significant for predicting liver transplantation (C-statistic 0.65 (0.53, 0.78)). SLPI also significantly improved the predictive performance of a clinical model for liver transplantation (integrated discrimination improvement (IDI): 0.090 (0.009, 0.210)). For other organs, clinical variables alone had strong predictive ability (C-statistic >0.80). Recipient 3-years survival was 80.0% (71.9%, 87.0%). Donor IL-6 was significantly associated with recipient 3-years survival (adjusted Hazard Ratio (95%CI): 1.26(1.08, 1.48), P = .004). Neither clinical variables nor biomarkers showed strong predictive ability for 3-year recipient survival. Plasma biomarkers in neurologically deceased donors were associated with organ use. SLPI enhanced prediction within a liver transplantation model, whereas IL-6 before transplantation was significantly associated with recipient 3-year survival. Clinicaltrials.gov: NCT00987714. •Selection criteria for organs from neurologically deceased donors are imperfect.•SLPI was significant for predicting liver transplantation.•SLPI also improved prediction of a clinical model for liver transplantation.•Clinical variables alone had strong predictive ability for other organs.•Donor IL-6 was significantly associated with recipient 3-years survival.•Neither clinical variables nor biomarkers had strong prediction for 3-yr survival.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Age / Biomarker / Biomarkers / Biomarkers - blood / Blood & organ donations / Brain death / Brain Death - immunology / Clinical trial / Critical care / Cytokines / Death & dying / Diabetes / Female / Graft Rejection - immunology / Graft Survival - immunology / Humans / Hypertension / Interleukin-6 - blood / Liver / Male / Middle Aged / Mortality / Organ donation / Organ Transplantation - mortality / Pancreas / Risk prediction / Secretory Leukocyte Peptidase Inhibitor - blood / Statistics / Tissue and Organ Procurement - methods / Transplantation / Transplants & implants / Variables