Deceased donor urinary Dickkopf-3 associates with future allograft function following kidney transplantation.

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 m ² ) than that in group B (44.2 mL/min/1.73 m ² ; 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 m ² 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.
Competing Interests: Declaration of competing interest The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. J.de Fallois is a member of the European Reference Network for Rare Kidney Diseases (ERKNet). A. Günzel received a doctoral stipend from the RES. C. Daniel receives funding from German Research Foundation (DFG; TR374 project number C2). K. Amann receives funding from German Research Foundation (DFG; TR374 project number C2). J. Halbritter receives funding from the German Research Foundation (DFG; project number HA 6908/4-1, HA 6908/7-1, and HA 6908/8-1) and is a member of the European Reference Network for Rare Kidney Diseases (ERKNet). Other authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.
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