Risk Assessment of Delayed Graft Function in Pediatric Kidney Transplantation – a CERTAIN Research Network Analysis

Delayed graft function (DGF) in pediatric kidney transplantation is a serious complication with negative impact on graft survival. Currently, there are no reliable methods available to assess the risk of DGF in children. We performed a retrospective analysis of data from the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) registry to develop a DGF risk assessment model for pediatric kidney transplantation, based on parameters available within the first 24 h post-transplant. The model was developed by forward selection and logistic regression. This study included n = 694 patients. The overall rate of DGF was 8.5%. The following key parameters were selected for the DGF risk assessment model: (i) occurrence of post-transplant surgical complications, (ii) immediate graft urine production, (iii) rate of change in recipient's serum creatinine, (iv) initial calcineurin inhibitor therapy. The significance of these parameters was confirmed by calculating adjusted odds ratios. In the training cohort and the internal validation cohort the ROC-AUCs were 0.9043 and 0.878. This multivariable model based on early post-transplant parameters can predict the occurrence of DGF in pediatric kidney transplant recipients with high accuracy and may facilitate future interventional trials of targeted pharmacological strategies against ischemia-reperfusion injury in this population.