The effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy

Anneke Kramer*, Vianda S. Stel, Ronald B. Geskus, E. Jane Tizard, Enrico Verrina, Franz Schaefer, James G. Heaf, Reinhard Kramar, Leah Krischock, Torbjørn Leivestad, Runólfur Pálsson, Pietro Ravani, Kitty J. Jager

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Background. Controversy exists concerning the timing of the first kidney transplantation for children who need to start renal replacement therapy (RRT). Our aim was to estimate the effect of timing of the first transplantation on patient survival in children, for the first time also taking into account the mortality on dialysis before transplantation. Methods. We included 2091 patients who started RRT between the age of 3 and 18 years in the period 1988- 2007, from 13 European renal registries. A multistate model was used to simulate patient survival assuming (i) pre-emptive transplantation, (ii) transplantation after 1 or 2 years on dialysis and (iii) remaining on dialysis. Results. Over the 20-year period, the highest 8-year survival probabilities were achieved in children transplanted pre-emptively {living donor (LD): 95.9% [95% confidence interval (CI): 93.1-98.8], deceased donor (DD): 95.3% (95% CI: 90.9-99.9)} rather than after 2 years of dialysis [LD: 94.2% (95% CI: 91.6-96.8), DD: 93.4% (95% CI: 91.0-95.9)], although these differences were not statistically significant. Conclusions. Even after taking mortality on dialysis into account, the potentially negative effect of postponing transplantation for 1 or 2 years was relatively small and not statistically significant. Therefore, if pre-emptive transplantation is not possible, starting RRT with a short period of dialysis and receiving a transplant thereafter seems an acceptable alternative from the perspective of patient survival.

Original languageEnglish
Pages (from-to)1256-1264
Number of pages9
JournalNephrology Dialysis Transplantation
Volume27
Issue number3
DOIs
Publication statusPublished - May 2012

Bibliographical note

Funding Information:
Acknowledgements. We would like to thank the patients and staff of all the dialysis and transplant units who have contributed data via their national and regional renal registries. Furthermore, we gratefully acknowledge the following registries and persons for their participation in the data collection: P. Castro de la Nuez and J. M. Muñoz Terol (Andalusian Renal Registry); Á. Magaz, J. Aranzabal, I. Lampreabe and J. Arrieta (Basque Country Renal Registry); E. Arcos, J. Comas, R. Deulofeu and J. Twose [Catalan Renal Registry (RMRC) and Catalan Transplant Organization (OCATT)]; A. Hemke [Dutch End-Stage Renal Disease Registry (RE-NINE)]; P. Finne and C. Grönhagen-Riska (Finnish Registry for Kidney Diseases); G.A. Ioannidis (Greek national Renal Registry); W. Metcalfe and K. Simpson (Scottish Renal Registry); S. Schön, A. Seeberger, L. Bäckman and B. Rippe [Swedish Renal Registry (SNR)] and O. Zur-riaga and M. Ferrer [Registro de Enfermos Renales de la Comunidad Valenciana (REMRENAL)] for providing data. In addition, we would like to thank A. H. Zwinderman (The Netherlands), C. Combe (France), F. Dekker (The Netherlands), A. Hoitsma (The Netherlands), F. Jarraya (Tunisia), K. Prütz (Sweden), K. Rönnholm (Finland) and I. Zamora (Spain, Comunidad Valenciana) for providing critical revision for important intellectual content of the article. The ERA–EDTA Registry is funded by the European Renal Association–European Dialysis and Transplant Association (ERA–EDTA).

Other keywords

  • Dialysis
  • Epidemiology
  • Kidney transplantation
  • Paediatric nephrology

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