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Sir, We read with interest the paper published by WesselingPerry et al., reporting the importance of Fibroblast Growth Factor 23 (FGF23) serum levels for predicting long-term renal graft survival and acute rejection frequency in paediatric renal transplant recipients, in a prospective cohort of 68 paediatric renal transplant recipients 4.9 6 0.5 years after transplantation, with a 2-year-follow-up after inclusion: baseline FGF23 serum levels predicted future episodes of rejection on the one hand and 30% of patients with baseline FGF23 >110 RU/mL had a final decrease in glomerular filtration rate (GFR) >50%, as estimated by the 2009 Schwartz formula on the other hand. They therefore concluded that FGF23 could be a predictor of both the decline of renal function and acute rejection in paediatric renal transplantation [1], similarly to the results obtained by Wolf et al. [2] in a prospective cohort of 984 transplanted adults, FGF23 being a risk factor for graft loss and mortality, even after adjustment for GFR. We would like to present our experience of FGF23 in stable paediatric transplantation, with a subgroup analysis of the INU23 study [3], in a group of 51 children with a past of solid organ transplantation (kidney n1⁄4 33, liver n1⁄4 13 and heart n 1⁄4 5, after excluding patients with genetic disorders with a likely bone impairment) and for whom renal evolution was available (date and results of the following inulin clearance). There were no differences for the evolution of inulin clearance in the two groups defined by a cut-off of baseline C-terminal FGF23 of 110 RU/mL (Table 1). Two patients had a final decrease in inulin clearance >50% (only one with Schwartz 2009), both with baseline FGF23 <110 RU/mL. Two children lost their graft (bad compliance) and one died (lymphoma), two of these three having baseline FGF23 >110 RU/mL. Even though these paediatric cohorts of prevalent transplant recipients recruited at variable durations after

FGF23 and paediatric transplantation: a single-centre French experience