High urinary excretion of kidney injury molecule-1 is an independent predictor of graft loss in renal transplant recipients

Transplantation. 2007 Dec 27;84(12):1625-30. doi: 10.1097/01.tp.0000295982.78039.ef.


Background: Chronic transplant dysfunction is characterized by renal function decline and proteinuria. Kidney injury molecule (KIM)-1, a transmembrane tubular protein with unknown function, is undetectable in normal kidneys, but markedly induced after injury. Urinary KIM-1 excretion has been quantified as biomarker of renal damage. We prospectively studied whether urinary KIM-1 predicts graft loss, independent of renal function and proteinuria.

Methods: Renal transplant recipients (n=145) visiting our outpatient clinic between August 2001 and July 2003 collected 24-hour urine samples for assessment of baseline urinary KIM-1 excretion (microsphere-based Luminex technology), and were followed for graft loss.

Results: Recipients participated at a median (interquartile range) of 6.0 (2.5-12.0) years posttransplant in baseline measurements. Follow-up beyond baseline was 4.0 (3.2-4.5) years. Urinary KIM-1 excretion was 0.72 (0.42-1.37) ng per 24 hours. Occurrence of graft loss increased over tertiles of KIM-1 excretion: 3 (6.3%), 11 (22.4%), and 17 cases (35.4%; P=0.001), respectively. High KIM-1 excretion was associated with proteinuria, low creatinine clearance, and high donor age (all P<0.01). In multivariate Cox regression analyses, prediction of graft loss by KIM-1 appeared independent of creatinine clearance, proteinuria, and donor age. Hazard ratios (95% CI) for the second and third tertile of KIM-1 excretion were 3.6 (0.9-13.5) and 5.1 (1.5-17.8) in the final model.

Conclusions: Urinary excretion of KIM-1 is an independent predictor of long-term graft loss and therefore a promising new biomarker in early prediction of graft loss.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / urine
  • Creatinine / metabolism
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Rejection / urine
  • Hepatitis A Virus Cellular Receptor 1
  • Humans
  • Kidney Transplantation / mortality
  • Kidney Transplantation / pathology*
  • Kidney Transplantation / physiology*
  • Male
  • Membrane Glycoproteins / urine*
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Proteinuria
  • Receptors, Virus
  • Survival Analysis
  • Time Factors
  • Treatment Failure


  • Biomarkers
  • HAVCR1 protein, human
  • Hepatitis A Virus Cellular Receptor 1
  • Membrane Glycoproteins
  • Receptors, Virus
  • Creatinine