One-year creatinine predicts long-term graft survival in pediatric kidney transplant recipients

Document Type

Article

Publication Date

4-1-2026

Publication Title

Pediatric nephrology (Berlin, Germany)

Keywords

Humans, Kidney Transplantation, Male, Female, Retrospective Studies, Graft Survival, Child, Creatinine, Adolescent, Glomerular Filtration Rate, Child, Preschool, Biomarkers, Graft Rejection, Predictive Value of Tests, Time Factors, Prognosis, Infant, Kaplan-Meier Estimate

Abstract

BACKGROUND: In pediatric kidney transplant, recipients' long-term graft survival remains variable necessitating methods to predict the timing of graft failure. Studies in adults have identified post-transplant serum creatinine (sCr) as a biomarker for graft survival. Our goal was to investigate the predictive value of 1-year sCr levels on long-term graft survival in pediatric kidney recipients.

METHODS: We performed a retrospective cohort study of Organ Procurement and Transplantation Network data. We identified 8733 pediatric kidney transplant recipients between 2008 and 2021 with reported 1-year sCr levels. Patients were grouped by sCr level: ≤ 1.0, 1.0-1.5, 1.5-2.0, and ≥ 2.0 mg/dL. We analyzed long-term graft survival with a Kaplan-Meier curve and a multivariable Cox proportional hazards model. We developed a predictive score derived from a sCr-based model and an estimated glomerular filtration rate (eGFR)-based model and compared them using DeLong's test.

RESULTS: Mean 1-year sCr was 0.88 mg/dL, and higher 1-year sCr predicted long-term graft failure (sCr 1.0-1.5 adjusted hazard ratio (aHR) 1.73, sCr 1.5-2.0 aHR 2.64, sCr ≥ 2.0 aHR 6.92, p <  0.001 for all). The mean 1-year eGFR was 71.66 mL/min/1.73 m(2). Compared to patients with eGFR ≥ 90, the risk of graft failure increased stepwise with lower eGFR (eGFR 60-90 aHR 1.27, eGFR 45-60 aHR 1.70, eGFR 30-45 aHR 2.62, eGFR <  30 aHR 9.05, p <  0.004 for all). Predictive ability was similar between eGFR- and sCr-based models (p = 0.116).

CONCLUSIONS: Utilizing 1-year sCr may allow for early identification of patients at risk of graft failure for careful surveillance and prognostication for patients' expectations.

Medical Subject Headings

Humans; Kidney Transplantation; Male; Female; Retrospective Studies; Graft Survival; Child; Creatinine; Adolescent; Glomerular Filtration Rate; Child, Preschool; Biomarkers; Graft Rejection; Predictive Value of Tests; Time Factors; Prognosis; Infant; Kaplan-Meier Estimate

PubMed ID

41275057

ePublication

ePub ahead of print

Volume

41

Issue

4

First Page

1169

Last Page

1179

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