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Although elevated plasma Regenerating islet\u2010derived 3\u03b1 (REG3\u03b1) and reduced citrulline levels have been associated with GI aGvHD, their kinetics and predictive value in pediatric HSCT remains unclear. We measured plasma REG3\u03b1 and citrulline levels weekly from pre\u2010conditioning to day +30 post\u2010transplant in 117 children (1\u201318\u2009years) undergoing myeloablative, matched\u2010donor HSCT. Patients developing GI aGvHD (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200916, 14%) exhibited significantly increased REG3\u03b1 levels from day +7 and onward, while citrulline levels were consistently reduced from before conditioning and during the first 2\u2009weeks post\u2010HSCT, particularly in those with lower GI aGvHD (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). No influence of GI infections was observed. In age\u2010, sex\u2010, diagnosis\u2010 and donor type\u2010adjusted analyses, increasing REG3\u03b1 (day +7) and decreasing citrulline (day 0) levels were independently associated with increased odds of lower GI aGvHD (OR\u2009=\u20092.25 (1.36\u20133.70), and OR\u2009=\u200915.43 (1.72\u2013138.15) per doubling\/5\u2009\u03bcmol\/L decrease,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). Both markers showed notable predictive value, with a sensitivity and specificity of 0.86 and 0.79 for REG3\u03b1 and 0.80\/0.83 for citrulline. Early post\u2010HSCT increases in REG3\u03b1 and reductions in citrulline may serve as prognostic biomarkers for GI aGvHD, particularly for identifying lower GI involvement, supporting their use for risk\u2010stratified immunosuppressive interventions.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70205","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T15:11:23Z","timestamp":1761318683000},"page":"1666-1674","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Monitoring plasma regenerating islet\u2010derived 3\u03b1 and citrulline levels during pediatric allogeneic hematopoietic stem cell transplantation to predict acute gastrointestinal graft\u2010versus\u2010host disease"],"prefix":"10.1002","volume":"158","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2364-4445","authenticated-orcid":false,"given":"Sarah","family":"Weischendorff","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine Rigshospitalet, University Hospital of Copenhagen  Copenhagen Denmark"},{"name":"Institute for Inflammation Research, Centre for Rheumatology and Spine Disease, Rigshospitalet University Hospital of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nakisa","family":"Kamari\u2010Kany","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine Rigshospitalet, University Hospital of Copenhagen  Copenhagen Denmark"},{"name":"Institute for Inflammation Research, Centre for Rheumatology and Spine Disease, Rigshospitalet University Hospital of Copenhagen  Copenhagen 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