ABSTRACT Background Accurate assessment of renal function through glomerular filtration rate (GFR) is a vital parameter in determining eligibility for hematopoietic stem cell transplantation (HSCT), as conditioning regimens often include nephrotoxic agents. Technetium‐99 m diethylenetriaminepentaacetic acid (Tc‐99m DTPA) nuclear scans are commonly used to measure GFR, but creatinine‐based formulas may be more convenient and cost‐effective. This study compared three contemporary creatinine‐based equations, the bedside Schwartz, Full Age Spectrum (FAS), and CKiD U25 creatinine equations with the Tc‐99 m DTPA measured GFR (mGFR) in pediatric HSCT candidates. Materials and Methods This retrospective cohort included 100 transplant episodes in pediatric patients undergoing autologous or allogeneic HSCT at King Abdulaziz Medical City, Jeddah. Agreement was evaluated using mean bias, standard deviation of the differences (precision), 95% limits of agreement, root‐mean‐square error, P10, P30, Lin's concordance correlation coefficient, and Bland–Altman analyses using both absolute and percentage differences. Exploratory subgroup analyses were conducted by sex and transplant type. Results The cohort included 59 male and 41 female transplant episodes; 57 were autologous and 43 were allogeneic. Mean Tc‐99 m DTPA mGFR was 113.0 mL/min/1.73 m 2 . Mean eGFR values were 112.4 for Schwartz, 102.2 for FAS, and 98.3 mL/min/1.73 m 2 for U25. Schwartz had the smallest mean absolute bias (−0.6 mL/min/1.73 m 2 ) but poor concordance (CCC 0.19), wide limits of agreement (−57.8 to 56.6), P10 of 27%, and P30 of 76%. FAS and U25 showed systematic underestimation, with biases of −11.0 and −14.7 mL/min/1.73 m 2 , respectively. Root‐mean‐square error was 29.0, 30.2, and 31.7 mL/min/1.73 m 2 for Schwartz, FAS, and U25, respectively. Performance remained limited across sex and transplant‐type subgroups. Conclusion None of the three creatinine‐based equations demonstrated sufficient individual‐level agreement with Tc‐99 m DTPA mGFR to replace measured GFR in pediatric HSCT candidates. Schwartz showed minimal average bias but substantial imprecision, whereas FAS and U25 tended to underestimate mGFR. Creatinine‐based eGFR remains useful for routine monitoring, but radionuclide measurement should be retained when precise renal assessment may affect transplant eligibility or nephrotoxic drug dosing.
ABSTRACT Background Liver transplantation is the definitive treatment for end‐stage liver disease in children. Despite improved survival, mortality and acute rejection remain significant. Evidence from developing countries is limited; therefore, this study aimed to evaluate one‐year mortality, acute rejection, and associated risk factors in pediatric liver transplant recipients at a national referral center in Indonesia. Methods A retrospective cohort study was conducted among pediatric liver transplant recipients aged < 18 years at Cipto Mangunkusumo Hospital (2010–2025). Survival was analyzed using the Kaplan–Meier method. Cox proportional hazards regression and logistic regression were applied to identify factors associated with one‐year mortality and acute rejection, respectively. Variables with p < 0.25 in univariate analysis and clinically relevant factors were included in multivariable models. Results A total of 87 patients were included. The one‐year mortality rate was 18.4% (overall survival 81.6%), with most deaths occurring within the first 5 months, particularly the first month. Operation duration > 12 h was independently associated with increased mortality (HR 4.13, 95% CI 1.16–14.64; p = 0.028). Acute rejection occurred in 27.6% of patients. No independent factor was significantly associated with acute rejection in multivariable analysis, although vascular complications showed a borderline association (OR 3.83, 95% CI 0.95–15.43; p = 0.059). Conclusions This study demonstrates favorable one‐year outcomes. Prolonged operative duration was independently associated with increased mortality, while no independent predictor was significantly associated with acute rejection. These findings highlight the importance of perioperative optimization and continued evaluation of factors influencing graft‐related outcomes.
ABSTRACT Background Allocation of high quality deceased donor kidneys to simultaneous pancreas–kidney (SPK) versus pediatric kidney alone (KI) recipients presents competing priorities regarding kidney allograft longevity and patient survival. We evaluated long‐term outcomes of contralateral kidneys transplanted into these distinct recipient populations to assess kidney allograft utility within this allocation framework. Methods Using Scientific Registry of Transplant Recipients data from 2010–2025, we identified 1675 deceased donors whose kidneys were transplanted into an adult SPK recipient and a pediatric KI recipient. Outcomes included death censored graft survival (DCGS), patient survival, and freedom from composite graft failure or death. Kaplan–Meier analyses were performed with survival estimates at 1, 3, 5, and 10 years and log‐rank comparisons. Results Ten‐year DCGS was significantly higher among adult SPK recipients than among pediatric KI recipients (82.1% versus 70.6%; p = 0.0001). Conversely, 10‐year patient survival was substantially higher among pediatric KI recipients (95.4% versus 78.3%; p = 0.0001). Despite these differences, 10‐year freedom from composite graft failure or death was comparable between SPK and pediatric KI recipients (69.1% versus 67.9%; p = 0.47). Conclusions Among contralateral kidneys from the same deceased donors, adult SPK recipients demonstrated superior DCGS, whereas pediatric KI recipients experienced substantially better patient survival. Comparable long‐term composite outcomes highlight the competing considerations of graft longevity and recipient survival in deceased donor kidney allocation. These findings suggest that assessments of kidney allograft utility should consider both graft‐specific and recipient‐centered outcomes rather than relying on either endpoint independently.
ABSTRACT Background Left lateral segment (LLS) grafts expand graft availability for infants and small children requiring liver transplantation (LT). However, their cumulative early postoperative burden compared with whole liver grafts (WLGs) remains incompletely characterized. Methods This retrospective single‐center cohort study included 95 consecutive primary pediatric LT recipients treated between 2019 and 2024, comprising 56 LLS and 39 WLG recipients. Cumulative postoperative morbidity within 90 days was quantified using the Comprehensive Complication Index (CCI). Additional outcomes included biliary and vascular complications, unplanned surgical reinterventions, length of stay, graft loss, retransplantation, and graft and patient survival. Results LLS recipients were younger and smaller than WLG recipients. Cumulative 90‐day morbidity was greater after LLS transplantation (median CCI 53 vs. 45, p = 0.002). LLS recipients had higher rates of bile leakage (18% vs. 3%, p = 0.024), intra‐abdominal bleeding (15% vs. 0%, p = 0.019), and unplanned surgical reintervention (43% vs. 8%, p < 0.001). Although the overall incidence of biliary complications was similar between groups, anastomotic biliary strictures during follow‐up were more frequent after WLG transplantation (28% vs. 9%, p = 0.014). Hospital stay was longer after LLS transplantation (median 43 vs. 27 days, p < 0.001). No statistically significant differences in graft loss, retransplantation, or graft and patient survival were detected between groups. Conclusions LLS transplantation was associated with greater cumulative morbidity within 90 days, characterized by higher rates of bile leakage, intra‐abdominal bleeding, unplanned surgical reintervention, and prolonged hospitalization. Despite this greater early postoperative burden, no statistically significant differences in graft loss, retransplantation, or graft and patient survival were detected during the available follow‐up. These findings support continued use of LLS grafts to expand transplant access. Given the associated early morbidity, it highlights the importance of an experienced surgical and medical team.
