Predicting future kidney allograft function is challenging. Novel biomarkers, such as urinary Dickkopf-3 (uDKK3), may help guide donor selection and improve allograft outcomes. In this prospective multicenter pilot trial, we investigated whether donor uDKK3 reflects organ quality and is associated with future allograft function. We measured uDKK3/crea ratios (uDKK3/crea) from 95 deceased and 46 living kidney donors. Prenephrectomy uDKK3/crea levels were 100× higher in deceased than in living donors (9888 pg/mg vs 113 pg/mg; P < .001). Among deceased donor transplantations, recipients were stratified by their corresponding uDKK3/crea donor levels ranging below (group A, n = 68) or above (group B, n = 65) median. The primary end point of best estimated glomerular filtration rate (eGFR) within the first 3 months after kidney transplantation was superior in group A (56.3 mL/min/1.73 m2) than that in group B (44.2 mL/min/1.73 m2; P = .0139). Second, the composite clinical end point consisting of death, allograft failure or eGFR decline >50% occurred less frequent in group A. By mixed linear regression modeling, donor uDKK3/crea remained an independent predictor of eGFR after transplantation, with a slope of −4.282 mL/min/1.73 m2 per logarithmic increase in donor uDKK3/crea. In summary, uDKK3 may serve as a noninvasive, donor-dependent biomarker for assessing organ quality and future allograft function.

中文翻译：

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已故供体尿液 Dickkopf-3 与肾移植后未来的同种异体移植物功能相关


预测未来的同种异体移植肾功能具有挑战性。新的生物标志物，如尿 Dickkopf-3 （uDKK3），可能有助于指导供体选择和改善同种异体移植结果。在这项前瞻性多中心试点试验中，我们研究了供体 uDKK3 是否反映器官质量并与未来的同种异体移植功能相关。我们测量了 95 名已故和 46 名活体肾脏供体的 uDKK3/crea 比率 （uDKK3/crea）。死者肾切除术前 uDKK3/crea 水平比活体供体高 100× （9888 pg/mg vs 113 pg/mg;P < .001）.在已故供体移植中，受者按相应的 uDKK3/crea 供体水平进行分层，范围低于 （A 组，n = 68） 或高于 （B 组，n = 65） 中位数。肾移植后前 3 个月内最佳估计肾小球滤过率 （eGFR） 的主要终点 A 组 （56.3 mL/min/1.73 m2） 优于 B 组 （44.2 mL/min/1.73 m2;P = .0139）。其次，由死亡、同种异体移植失败或 eGFR 下降 >50% 组成的复合临床终点在 A 组中发生率较低。通过混合线性回归模型，供体 uDKK3/crea 仍然是移植后 eGFR 的独立预测因子，供体 uDKK3/crea 每对数增加的斜率为 -4.282 mL/min/1.73 m2。总之，uDKK3 可作为一种无创、供体依赖性生物标志物，用于评估器官质量和未来的同种异体移植物功能。