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Updated: Aug 12, 2026
08:12
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Machine Perfusion and Mitigating Risk Factors for Delayed Graft Function in Pediatric Kidney Transplant Recipients
Kyle A Merrill1,2, Cassie Kirby3, Teresa Ambrosino4
1Division of Nephrology, Dialysis and Transplantation, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA.
Pediatric Transplantation
|August 11, 2026
Summary
Prolonged warm ischemia time (WIT) increases delayed graft function (DGF) risk in pediatric kidney transplants. Machine perfusion (MP) appears protective, potentially reducing DGF and mitigating cold ischemia time (CIT) effects.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Organ Preservation
Background:
- Kidney transplantation offers improved outcomes for end-stage kidney disease (ESKD) patients compared to dialysis.
- Delayed graft function (DGF) is a significant risk factor for allograft rejection and reduced graft survival.
- While risk factors for DGF in adults are known, data for pediatric kidney transplant recipients is limited.
Purpose of the Study:
- To identify risk and protective factors for DGF in pediatric kidney transplant recipients.
- To investigate the impact of warm ischemia time (WIT), cold ischemia time (CIT), and machine perfusion (MP) on DGF incidence.
Main Methods:
- Retrospective analysis of pediatric kidney transplant recipients (18 months to 21 years) between November 2017 and November 2021.
- DGF defined as requiring dialysis within 7 days post-transplant.
- Evaluation of WIT, CIT, donor type (deceased donor - DD), and MP as potential factors.
Main Results:
- 10% of pediatric recipients (9/89) developed DGF.
- Longer WIT was significantly associated with increased DGF risk (p=0.002).
- Deceased donor allografts were associated with higher DGF risk (RR 1.7).
- Machine perfusion (MP) of deceased donor kidneys was associated with zero DGF cases.
- MP mitigated the negative impact of WIT on DGF in DD recipients.
Conclusions:
- Increased WIT is a significant risk factor for DGF in pediatric kidney transplantation.
- Machine perfusion (MP) demonstrates a protective effect against DGF and may offset prolonged CIT.
- DGF is relatively rare in this pediatric cohort, necessitating further research due to low incidence.
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