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

Abstract

Purpose: We sought to build prediction models for organ transplantation and recipient survival using both biomarkers and clinical information.

Materials and methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Biomarker; Brain death; Clinical trial; Organ donation; Risk prediction; Transplantation.

Copyright © 2018 Elsevier Inc. All rights reserved.

Figures

Figure 1.. Study flow and cohort selection.

Out of 556 neurologically deceased organ donors, 505 donors had complete clinical data. From four clinical data sites, we collected plasma analysis (n=120). After excluding missing or aborted data (n=23), 97 donors containing both complete clinical and biomarker information were included in our final data set.