Preoperative Nutritional Indices Predicting Delayed Graft Function in Pediatric Kidney Transplantation

Area of Science:

• Pediatric Nephrology
• Transplant Immunology
• Nutritional Biomarkers

Background:

• Delayed graft function (DGF) is a significant complication in pediatric kidney transplantation.
• Predictive markers for DGF are crucial for optimizing patient outcomes.
• The Prognostic Nutritional Index (PNI), combining serum albumin and lymphocyte count, is a readily available metric of nutritional and immune status.

Purpose of the Study:

• To evaluate the Prognostic Nutritional Index (PNI) as a predictor of delayed graft function (DGF) in pediatric kidney transplant recipients.
• To assess the utility of PNI in identifying children at high risk for DGF pre-transplant.

Main Methods:

• Retrospective review of pediatric kidney transplant recipients (aged 1-18 years) from January 2013 to December 2024.
• Collection of recipient/donor demographics, clinical data, and preoperative laboratory values.
• Calculation of PNI and other inflammatory indices (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammatory index).

Main Results:

• 17.3% of 162 children experienced delayed graft function.
• Each 1-point increase in PNI was associated with an 8% lower risk of DGF (OR 0.92, P=.042).
• Higher neutrophil-to-lymphocyte ratio predicted increased DGF risk (OR 1.30, P=.016); higher platelet-to-lymphocyte ratio showed a protective effect (OR 0.99, P=.041).

Conclusions:

• The Prognostic Nutritional Index is a strong predictor of delayed graft function in pediatric kidney transplant recipients.
• Integrating PNI and inflammatory indices into preoperative assessments can aid in early identification of high-risk patients.
• This approach may inform donor selection and perioperative management to improve graft outcomes.