# Early Post-Transplant Urinary EGF as a Potential Predictor of Long-Term Allograft Loss in Kidney Transplant Recipients

## TL;DR

This study suggests that measuring urinary EGF three months after kidney transplant may help predict long-term graft failure, but more research is needed to confirm its usefulness.

## Contribution

The study introduces urinary EGF as a novel biomarker for predicting long-term allograft loss in kidney transplant recipients.

## Key findings

- Lower urinary EGF levels were independently associated with allograft loss in the main cohort.
- Adding urinary EGF to existing models improved prediction accuracy and reduced model complexity.
- Temporal validation did not confirm the independent association of urinary EGF with allograft loss.

## Abstract

Improved biomarkers are needed to enhance prognostication in kidney transplantation. We evaluated urinary Epidermal Growth Factor (uEGF) as a predictor of long-term allograft loss. We conducted a prospective, single-center cohort study of 290 adult kidney transplant recipients with uEGF measured 3 months post-transplant. The primary outcome was allograft loss, defined as return to dialysis or pre-emptive re-transplantation. Multivariable cause-specific Cox models assessed the independent association between uEGF and allograft loss. Model performance was compared to an existing prediction model using 7-year time-dependent AUC and Akaike Information Criterion (AIC), with internal validation via bootstrap resampling. Temporal validation was performed in an independent cohort of 203 patients. uEGF correlated with markers of chronic injury, including eGFR, donor age, and interstitial fibrosis. After a median 8.8- year follow-up, lower uEGF was independently associated with allograft loss (adjusted HR 0.19; 95% CI, 0.11−0.32). Adding uEGF to the existing prediction model improved discrimination (AUC 0.72 vs. 0.63) and reduced AIC (383 vs. 394). While results were robust to internal validation, temporal validation did not show an independent association of uEGF with allograft loss. These findings suggest uEGF may provide independent prognostic value, but further studies in larger and more diverse cohorts are needed to confirm its clinical utility.

A study explores early post-transplant urinary EGF as a predictor of kidney transplant recipients' long-term allograft loss. The setting involves a single-center cohort and temporal validation cohort with 290 and 203 participants, respectively. Factors linked to three-month uEGF include eGFR, age, interstitial fibrosis, and sex. The main cohort shows uEGF association with allograft loss, enhancing prediction models with bootstrap validation. The validation cohort shows no eGFR-independent association. A graph displays the log uEGF-to-creatinine ratio versus relative hazard ratio for kidney failure. Study by Creon A., published in Transplant International 2025.