Early postoperative galectin-3 for risk stratification of delayed graft function after kidney transplantation

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Abstract
Background: Delayed graft function (DGF) is a major early complication after kidney transplantation. Galectin-3 (Gal3), a mediator of inflammation and fibrosis, is associated with renal injury, but its role in predicting DGF remains unclear. This study evaluated whether early postoperative Gal3 levels predict DGF and clinical outcomes. Methods: This single-center retrospective cohort study included adult kidney transplant recipients from deceased donors (January 2021–December 2022). Gal3 was measured preoperatively, at intensive care unit (ICU) admission, and at ICU discharge. The primary outcome was DGF, defined as renal replacement therapy within 7 days. A base clinical model (age, cold ischemia time, creatinine at ICU admission) was compared with a Gal3-extended model, assessed by area under the curve (AUC), Brier score, calibration, bootstrap optimism correction, and categorical net reclassification improvement. Results: Among 182 patients, 35 (19.2%) developed DGF. Gal3 at ICU admission was significantly higher in DGF patients (52.3 vs. 40.0 ng/ml, P < .001) and was independently associated with DGF (odds ratio per 5-ng/ml increase: 1.19; 95% confidence interval: 1.05–1.35; P = .008). Adding Gal3 modestly improved the AUC from 0.705 to 0.744 and the Brier score from 0.144 to 0.139. The Gal3-extended model retained superior discrimination after bootstrap correction. An exploratory prediction score demonstrated increasing DGF risk across score categories. Conclusion: Gal3 measured at ICU admission was independently associated with DGF and provided modest incremental risk-stratification value. External validation is required before clinical implementation.

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