Background: Delayed graft function (DGF) is a clinically important early complication following pediatric renal transplantation, often associated with longer hospitalization and poorer graft outcomes. Despite improved surgical techniques and immunosuppression protocols, the occurrence of DGF remains a concern. Understanding the donor- and recipient-related predictors of DGF is essential to optimize outcomes in this vulnerable population. This study aims to explore clinical, laboratory, and transplant-related factors associated with DGF in pediatric renal transplant recipients.
Materials and Methods: This retrospective cohort study included pediatric patients aged 1–18 years who underwent renal transplantation at Başkent University Hospital from January 2013 to December 2023. Of 157 recipients, patients were classified based on the presence or absence of DGF, defined as dialysis requirement within the first week post-transplant. Donor and recipient demographics, clinical variables, and pre-transplant inflammatory markers Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII) were analyzed.
Results: Among 157 pediatric kidney transplant recipients, 28 (17.8%) DGF. There were no significant differences in recipient age or gender between the DGF and non-DGF groups (p > 0.05). The most common underlying etiology of renal failure was congenital anomalies of the kidney and urinary tract (25.5%), followed by glomerular diseases (21.0%) and tubulointerstitial disorders (16.6%). Donor-related factors significantly associated with DGF included younger donor age (p = 0.0031) and a higher proportion of cadaveric donors in the DGF group (32.1% vs. 7.0%; p = 0.0006). Focal segmental glomerulosclerosis was also significantly more common in the DGF group (p < 0.05). Preoperative inflammatory markers such as platelet-to-lymphocyte ratio (PLR) (160.0 vs. 221.3; p = 0.013) and systemic immune-inflammation index (SII) (643.1 vs. 951.1; p = 0.032) were significantly lower in the DGF group, while the neutrophil-to-lymphocyte ratio (NLR) showed no significant difference (p > 0.05). No significant associations were observed with recipient weight, height, dialysis duration, mode of dialysis, blood group, or preoperative hemoglobin levels (p > 0.05). The most common complications across the cohort included infections (6.6%), fluid-related issues (6.0%), neurological complications (6.0%), and rejection episodes (6.0%), with no statistically significant differences between the groups.
Conclusion: Donor-related factors and pre-transplant inflammatory markers play a critical role in the development of delayed graft function in pediatric renal transplantation. Assessing these variables preoperatively can help identify high-risk recipients and guide donor selection and perioperative management to improve early graft outcomes.