Preoperative Nutritional Indices Predicting Delayed Graft Function in Pediatric Kidney Transplantation

The Prognostic Nutritional Index, which combines serum albumin and lymphocyte count, captures protein reserves and immune competence in a single, easily obtained metric. Whether this index can predict delayed graft function among pediatric kidney transplant recipients has not been thoroughly evaluated. Here, we examined whether use of this index pretransplant can predict delayed graft function in this population.

We reviewed children (aged 1 -18 years )who received kidney transplants at Başkent University Hospital from January 2013 to December 2024. Patients were stratified by delayed graft function status. We collected recipient and donor demographics, clinical characteristics, and routine preoperative laboratory values. The Prognostic Nutritional Index and other inflammatory indices (neutrophil -to -lymphocyte ratio, platelet -to -lymphocyte ratio, and systemic inflammatory index derived from the same preoperative blood counts ) were calculated.

Twenty -eight of 162 children (17.3 % ) experienced delayed graft function. In regression analysis, each 1 -point increase in the Prognostic Nutritional Index, which reflects better nutritional and immune status, was linked to an 8 % lower chance of developing delayed graft function (odds ratio 0.92; 95 % CI, 0.85 -0.99; P = .042 ). Higher neutrophil -to -lymphocyte ratio indicated significantly greater risk of delayed graft function (odds ratio 1.30; 95 % CI, 1.05 -1.61; P = .016 ), and a 1 -unit rise in the platelet -to -lymphocyte ratio provided a small but meaningful protective effect (odds ratio 0.99; 95 % CI, 0.993 -0.999; P = .041 ). Higher systemic inflammatory index indicated a slightly lower risk of delayed graft function (odds ratio 0.9997 /unit increase; P =.049 ). Recipient characteristics did not differ between those with and without delayed graft function.

Among the study patients, the Prognostic Nutritional Index emerged as a strong predictor of delayed graft function. Integrating this index with simple inflammatory indices into preoperative assessments may enable early identification of high -risk children, inform donor selection, and guide perioperative management to improve graft outcomes.