Machine Perfusion and Mitigating Risk Factors for Delayed Graft Function in Pediatric Kidney Transplant Recipients

Kidney transplantation confers prolonged and improved quality of life versus dialysis for patients with end-stage kidney disease (ESKD). Delayed graft function (DGF) increases the risk of allograft rejection and decreases allograft survival. In adults, prolonged warm (WIT) and cold ischemia time (CIT) increase risk of DGF, and machine perfusion (MP) during organ transportation reduces this risk. However, there is a paucity of data regarding risk factors for DGF in children.

We retrospectively evaluated risk and protective factors for DGF in patients aged 18 months to 21 years who underwent kidney transplantation at Cincinnati Children's Hospital Medical Center between 11/1/2017 and 11/30/2021. DGF was defined as receiving dialysis within 7 days post-transplant.

Nine of 89 (10%) patients developed DGF. Patients with DGF had longer median WIT (49 IQR: 44-57 vs. 37 min IQR: 30-43; p = 0.002) and were more likely to have received a deceased donor (DD) allograft (p = 0.04, RR1.7 (95% CI: 1.2-2.4)). There was no difference in CIT between those who did and did not experience DGF (464 IQR:329-788 vs. 271 min. IQR:271-788; p = 0.16). No patients who received DD-MP kidneys developed DGF. DGF in recipients of DD-non-MP kidneys had longer WIT (53 IQR: 43-57 vs. 36 min. IQR: 30-44; p < 0.009).

Increased WIT increases the risk of DGF in pediatric kidney transplant recipients, whereas MP appears to be protective against DGF and may ameliorate the adverse effect of CIT. DGF was rare in the cohort and further studies are necessary due to the low incidence of DGF.