# Novel Kidney Injury Tools in Deceased Organ Donation to Predict Graft Outcomes

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $663,452

## Abstract

Efforts to meet the increasing need for kidney transplantation have resulted in more
kidney procurements from older and sicker donors, but have also unfortunately led to
greater discard rates of procured kidneys. Although a subset of these organs are
unsuitable for transplantation, many kidneys are unnecessarily discarded due to the
inability to accurately assess graft quality and predict graft outcomes, often driven by
unfavorable scores on the kidney donor profile index (KDPI), a widely used but
inadequate metric for evaluating the quality of donated kidneys. The objective of the
Deceased Donor Study is to gain insight into the biological processes that affect kidney
quality during donor death and organ procurement. Phases 1 and 2 of the study
generated novel insights into donor pathophysiology and revealed limitations in organ
quality assessment, which motivate this renewal application. After evaluating >30 urine
biomarkers collected from >1,500 donors, a protective effect for increasing donor
urinary levels of repair biomarkers (e.g., YKL-40, uromodulin, and osteopontin), on long-
term graft function in >2,500 recipients was demonstrated. In phase 3, these urinary
repair biomarker results will begin to be validated and implemented in organ allocation
process using real-time point-of-care tests. In collaboration with organ procurement
organizations, repair biomarkers in samples from 500 donors with acute kidney injury
(AKI) or high-risk KDPIs will be measured prospectively on site. Additional racial
diversity will be included in our cohort in collaboration with the multicenter APOL1 Long-
term Kidney Transplantation Outcomes Network to assess the differential response in
recipient allograft outcomes to the APOL1 genotype more commonly present in Black
donors. Lastly, in collaboration with the United Network for Organ Sharing laboratory,
“adjusted” KDPIs will be provided for donors with AKI based on creatinine trajectory,
genetic risk variants, and biomarker information, with the aim of improving kidney
acceptability. These new tools may also provide a platform for enhancing understanding
of the natural history of deceased-donor kidney transplantation, advancing the science
of renal injury and repair as it relates to donor race, and determining the best
approaches for transplanting kidneys at risk for discard.

## Key facts

- **NIH application ID:** 10755359
- **Project number:** 5R01DK093770-11
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Chirag R Parikh
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $663,452
- **Award type:** 5
- **Project period:** 2012-08-15 → 2026-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10755359

## Citation

> US National Institutes of Health, RePORTER application 10755359, Novel Kidney Injury Tools in Deceased Organ Donation to Predict Graft Outcomes (5R01DK093770-11). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10755359. Licensed CC0.

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