Objectives: Delayed graft function (DGF) is a common adverse outcome after renal transplantation. Delayed graft function is defined as the need for dialysis intervention within the first week of transplantation and/or creatinine reduction ratio less than 70 percent between day 0 and day 7 after transplantation. An early prediction and prevention of delayed graft function is often challenging and misleading. Herein, we investigated the correlation between delayed graft function and preoperative non-invasive hematologic parameters to predict the possible adverse outcomes prior to the renal transplantation in pediatric patients for the first time.

Material and Methods: In this retrospective study, we included a total of 100 pediatric patients (Male/Female: 64/36), aged between 1-18 years, who underwent renal transplantation at Başkent University Hospital, Ankara, Turkey and evaluated their preoperative complete blood count for platelet x neutrophil to lymphocyte ratio (SII), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). Receiving operating characteristic (ROC) curve analysis was performed to classify the optimal cut-off values for SII, NLR and PLR with highest sensitivity and specificity. We compared the preoperative hematologic parameters of 23 patients with DGF and 77 patients without DGF and assessed the correlation between DGF and SII, NLR and PLR.

Results: There were no significant differences in gender, age at transplantation, laterality of kidney transplantation, preoperative neutrophils, thrombocytes, and white blood cells count between the patients with or without DGF. Median circulating lymphocyte value was significantly higher in DGF when compared to the non-DGF patients (p<0.05). Furthermore, the median value for SII, NLR and PLR was significantly lower in DGF when compared to the non-DGF patients (490.3 vs 1159.1, p=0.004; 1.6 vs 6.0, p=0.004; and 95.1 vs 178.6, p=0.017 respectively). A cut-off value 700 for SII, 5 for NLR and 175 for PLR was identified with highest sensitivity and specificity. Based on these cut-off values, low level of SII, NLR and PLR had higher proportion of delayed graft function when compared to non-DGF patients (73.9% vs 40.3%, p=0.004; 73.9% vs 39.0%, p=0.003; and 82.6% vs 49.4%, p=0.004).

Conclusions: In our study, pre-transplanted low SII, NLR and PLR was inversely associated with DGF, therefore, these novel and non-invasive inflammatory biomarkers may contribute to an early prediction of DGF in kidney transplant recipients.