Ann Surg Treat Res.  2020 Jun;98(6):332-339. 10.4174/astr.2020.98.6.332.

Klotho as a potential predictor of deceased donor kidney transplantation outcomes

• Kim SM
• Han A
• Ahn S
• Min SI
• Min SK
• Ha J

• KMID: 2502119
• DOI: http://doi.org/10.4174/astr.2020.98.6.332

Abstract

Purpose
Klotho is an antiaging factor mainly produced by renal tubular cells. Klotho is reportedly decreased in an animal model of acute kidney injury and patients with chronic kidney disease. However, information on Klotho expression after kidney transplantation is limited. We analyzed the correlation between donor Klotho expression and clinical outcomes of kidney transplantation.
Methods
Sixty patients who underwent deceased donor kidney transplantation between March 2015 and October 2017 were enrolled. Serum and tissue Klotho expression levels were measured by enzyme-linked immunosorbent assay and immunohistochemistry, respectively. Graft function was assessed by estimated glomerular filtration rate (eGFR).
Results
Patients were divided into 2 groups according to donor Klotho expression in renal tissues. A greater improvement in eGFR was observed at 1 week after transplantation in patients receiving kidneys with higher Klotho expression (47.5 ± 21.9 mL/min/1.73 m2 vs. 63.9 ± 28.2 mL/min/1.73 m2, P = 0.030). Patients were also classified into 2 groups according to donor serum Klotho level. There was a tendency for a higher eGFR at 12 months after transplantation in patients receiving kidneys from donors with a higher Klotho level (51.0 ± 18.0 mL/min/1.73 m2 vs. 61.2 ± 16.5 mL/min/1.73 m2, P = 0.059). When subgrouped into patients with or without biopsy-proven acute rejection, 12-month eGFR remained higher in patients receiving kidneys from donors with higher serum Klotho.
Conclusion
Our data demonstrated that donor tissue expression of Klotho correlated with early recovery of eGFR after kidney transplantation. Donor serum Klotho level tended to be associated with posttransplant 12-month eGFR. Donor Klotho expression might be a new predictor for deceased donor kidney transplantation outcome.

Keyword

Deceased donor; Kidney transplantation; Klotho

Figure

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  Fig. 1 Correlation between serum Klotho level and final creatinine level before procurement in donor (A) and donor age (B).

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  Fig. 2 Immunohistochemistry of an implant (A), a 10-day (B), and a 1-year (C) posttransplantation biopsy (magnification, ×200; scale bar = 100 µm).

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  Fig. 3 Estimated glomerular filtration rate (GFR) after transplants according to the expression of Klotho in donor renal tissue.

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