Do Perioperative Surgical Factors Affect Early Graft Function in Pediatric Kidney Transplantation?

BACKGROUND: Early graft function after pediatric kidney transplantation (KT) may be influenced by perioperative hemodynamic and fluid management variables. However, previous studies have yielded conflicting results. This study aimed to evaluate the impact of perioperative factors on early graft function in pediatric KT recipients. METHODS: This retrospective multicenter study included pediatric KT recipients from four academic centers in Turkiye and France. Early graft function was assessed using estimated glomerular filtration rate (eGFR) at postoperative day 7 and day 30. Delayed graft function (DGF) was defined as the need for dialysis within the first 7 days post-transplant. Mean arterial pressure (MAP) was calculated where reperfusion blood pressure data were available, and a sensitivity analysis accounting for transplant center was performed. Associations between perioperative variables and outcomes were evaluated using univariate and multivariate regression analyses. RESULTS: Ninety-seven patients were included (median age 154 months; 45.4% female). DGF occurred in 11.3% of recipients. In multivariate analysis, no perioperative variable was independently associated with DGF. Longer cold ischemia time was independently associated with lower 7-day eGFR (B = -0.05; 95% CI -0.10 to -0.01; p = 0.014). At 30 days, preemptive transplantation (B = -15.99; 95% CI -27.02 to -4.96; p = 0.005) and DGF (B = -36.94; 95% CI -58.39 to -15.50; p = 0.001) were independently associated with lower eGFR; the preemptive association was attenuated after accounting for transplant center. CONCLUSION: Intraoperative hemodynamic parameters were not independently associated with DGF or early graft function. At day 7, early graft function was primarily associated with cold ischemia time, whereas at day 30 it was mainly associated with preemptive transplantation status and DGF.