Furosemide Stress Test as a Predicting Biomarker for Delayed Graft Function in Kidney Transplantation

Abstract

Background: Delayed graft function (DGF) could worsen early and long-term outcomes of kidney transplantation (KT). DGF is caused by several pre-transplantation and perioperative factors in both donors and recipients. At present, there are no biomarkers or tests during the immediate post-KT period that can accurately predict the development of DGF. Materials and methods: This prospective study was conducted in deceased donor KT (DDKT) at King Chulalongkorn Memorial Hospital, Thailand. All recipients underwent furosemide stress test (FST) by receiving a single dose of intravenous furosemide, 1.5 mg/kg at 3 h after allograft reperfusion. We determined the correlations between DGF (requiring dialysis within the first week after transplantation) and the values of urine volume recorded hourly after FST until 6 h, the parameters of postoperative dynamic tests, including resistive index (RI) of renal arteries and effective renal plasma flow (ERPF), and urine neutrophil gelatinase-associated lipocalin (NGAL). Results: Of the 59 total DDKT recipients enrolled, 24 developed DGF. The FST is a more accurate biomarker than urine NGAL, RI of renal arteries, and ERPF in the prediction of DGF. The 4-h urine volume less than 350 mL (FST non-responsive) was the best cut-off value in predicting DGF with 87.5% sensitivity, 82.9% specificity, and 82.5% accuracy. Multiple logistic regression analyses showed an odds ratio of 0.993 (0.986–0.999, p = 0.035) for the 4-h urine volume to predict DGF. Conclusions: The FST is a simple and accurate biomarker for predicting DGF in early post-KT period. Close monitoring and well prepared dialysis are suggested in patients with urine volume < 350 mL after 4 h of FST. The FST non-responsive patients could be the target for further DGF preventive intervention. ClinicalTrials.gov identifier: NCT03071536.

Approach and Management of Hypertension After Kidney Transplantation

“…Furosemide is the most commonly used loop diuretic. It has been used to predicting progression of AKI with the so-called furosemide stress test (FST) in non-transplant patients (145,146). Loop diuretics can also provide prognostic value in regard to renal allograft function in the immediate post-transplant period.…”

Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function

“…Ideally, kidneys will be neither wasted nor used in poor condition. Of course, it is difficult to achieve this, and additional in-depth evaluation systems, such as molecular markers, irrigation fluid culture, susceptibility-weighted imaging and other information, need to be further investigated to improve quality of organ transplantation [28][29][30][31].…”

Furosemide stress test and interstitial fibrosis in kidney biopsies in chronic kidney disease

“…This test performed better than many of the urinary biomarkers used to predict AKI. Subsequent studies of FST in AKI have demonstrated that the FST performance is robust and performs consistently for the assessment of AKI progression and recovery [45][46][47][48].However, none these studies measured the excreted mass of furosemide.…”