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

Christian Patry1, Miriam Boßung1, Manuel Feißt2

  • 1Department of Pediatrics I, Medical Faculty, Heidelberg University, University Children's Hospital Heidelberg, Heidelberg, Germany.

Transplant International : Official Journal of the European Society for Organ Transplantation
|April 6, 2026
PubMed

Insights

A new model accurately predicts delayed graft function (DGF) in pediatric kidney transplants using early post-transplant data. This tool aids in identifying high-risk children, potentially improving graft survival and guiding future research.

Area of Science:

  • Nephrology
  • Pediatric Transplantation
  • Medical Informatics

Background:

  • Delayed graft function (DGF) is a significant complication in pediatric kidney transplantation, impacting long-term graft survival.
  • Current methods for assessing DGF risk in children are unreliable.
  • Early identification of DGF risk is crucial for timely intervention and improved outcomes.

Purpose of the Study:

  • To develop and validate a predictive model for DGF in pediatric kidney transplant recipients.
  • To identify key early post-transplant parameters associated with DGF risk.
  • To provide a tool for risk stratification in pediatric kidney transplantation.

Main Methods:

  • Retrospective analysis of 694 patients from the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) registry.
  • Development of a DGF risk assessment model using forward selection and logistic regression.
  • Internal validation of the model using ROC-AUC analysis.

Main Results:

  • The overall DGF rate was 8.5%.
  • Key predictors identified include post-transplant surgical complications, immediate graft urine production, recipient serum creatinine change, and initial calcineurin inhibitor therapy.
  • The model demonstrated high predictive accuracy with ROC-AUCs of 0.9043 (training) and 0.878 (validation).

Conclusions:

  • A multivariable model utilizing early post-transplant parameters accurately predicts DGF in pediatric kidney transplant recipients.
  • This predictive model can aid in identifying high-risk patients and facilitate targeted interventional trials.
  • The findings support the development of strategies to mitigate ischemia-reperfusion injury in pediatric kidney transplantation.

Keywords:
delayed graft functionischemia-reperfusion injurypediatric kidney transplantationpost-transplant complicationsrisk assessment model

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