Access to kidney transplantation and re-transplantation from childhood to adulthood: long-term data from the ERA Registry.

IF 5.6 2区医学 Q1 TRANSPLANTATION

Nephrology Dialysis Transplantation Pub Date : 2025-08-01 DOI:10.1093/ndt/gfaf025

Evgenia Preka, Marjolein Bonthuis, Stephen D Marks, Anneke Kramer, Aiko P J de Vries, Søren S Sørensen, Sevcan A Bakkaloğlu, Claus Bistrup, Timo Jahnukainen, Olga L Rodriguez Arévalo, Lukas Buchwinkler, Mårten Segelmark, J Emilio Sanchez, Miha Arnol, Flor A Ordóñez-Álvarez, Francisco de la Cerda-Ojeda, Lucy A Plumb, Shona Methven, Runolfur Palsson, Torbjörn Lundgren, Héctor Ríos, Alberto Ortiz, Vianda S Stel, Jerome Harambat, Kitty J Jager

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引用次数: 0

Abstract

Background and hypothesis: Knowledge regarding access to first kidney transplantation (KT) and subsequent KT in patients commencing kidney replacement therapy (KRT) in childhood is limited.

Methods: Using European Renal Association (ERA) Registry data, we investigated European patients who started KRT below 20 years of age between 1978 and 2019. Access and determinants to first, second, and third KT were assessed using multivariable Cox regression.

Results: Totals of 12 623, 4077, and 1186 patients were included while awaiting first, second, and third KT, at median ages of 13.8 (IQR: 7.5-17.4), 20.9 (IQR: 16.5-26.1), and 26.6 (IQR: 20.3-32.8) years, respectively. During the study period, overall access was 87.8%, 72.7%, and 60.5% for first, second, and third KT, respectively, and median time to each KT was 0.9 (IQR: 0.2-2.1), 1.9 (0.6-4.5), and 2.6 (IQR: 1.0-5.3) years. Younger age at KRT initiation (aHR 0-4 vs. 10-14 years: 0.54; 95%CI: 0.51-0.57) and female sex (HR: 0.94; 95%CI: 0.90-0.98) were associated with lower access to first KT. KT candidates between 15 and 19 years had lower access to first and second KT (aHR: 0.69; 95%CI: 0.66-0.73, and aHR: 0.70; 95%CI: 0.61-0.81) compared to 10-14 year-olds. Compared to CAKUT, glomerulonephritis patients had lower access to KT (aHR: 0.75; 95%CI: 0.71-0.80 for first, aHR: 0.89; 95%CI: 0.81-0.98 for second, and aHR: 0.80; 95%CI: 0.66-0.97 for third KT). Similarly, patients with primary renal diseases with high risk of recurrence, had lower chances of receiving a first and second KT (aHR: 0.80; 95%CI: 0.76-0.85 for first, aHR: 0.86; 95%CI: 0.78-0.95 for second KT). Access to re-transplantation was also higher with previous pre-emptive KT and previous graft survival exceeding 5 years.

Conclusion: Our study highlights KT access disparities particularly for females, the youngest recipients, high-risk age (15-19 years), and diseases with recurrence risk. Notably, pre-emptive transplants and enduring previous grafts offer advantages regarding re-transplantation.

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从儿童期到成年期肾移植和再移植的可及性：ERA Registry的长期数据。

背景和假设：关于儿童期开始肾脏替代治疗（KRT）的患者获得首次肾移植（KT）和后续KT的知识有限。方法：使用欧洲肾脏协会（ERA） Registry的数据，我们调查了1978年至2019年期间20岁以下开始KRT的欧洲患者。使用多变量Cox回归评估第一、第二和第三KT的获取和决定因素。结果：12 623例、4077例和1186例患者在等待第一次、第二次和第三次KT时被纳入，中位年龄分别为13.8 （IQR: 7.5-17.4）、20.9 （IQR: 16.5-26.1）和26.6 （IQR: 20.3-32.8）岁。在研究期间，第一、第二和第三KT的总体可及性分别为87.8%、72.7%和60.5%，每个KT的中位时间分别为0.9 （IQR: 0.2-2.1）、1.9（0.6-4.5）和2.6 （IQR: 1.0-5.3）年。开始KRT时年龄较小(aHR 0-4 vs. 10-14岁：0.54；95%CI: 0.51-0.57)和女性(HR: 0.94；95%CI: 0.90-0.98)与第一KT通路较低相关。15-19岁的KT候选人获得第一和第二KT的机会较低(aHR: 0.69；95%CI: 0.66-0.73, aHR: 0.70；95%CI: 0.61-0.81)，与10-14岁的儿童相比。与CAKUT相比，肾小球肾炎患者获得KT的机会更低(aHR: 0.75；95%CI: 0.71 ~ 0.80, aHR: 0.89；95%CI: 0.81-0.98, aHR: 0.80；95%CI: 0.66-0.97（第三KT）。同样，复发风险高的原发性肾脏疾病患者接受第一次和第二次KT的机会较低(aHR: 0.80；95%CI: 0.76 ~ 0.85, aHR: 0.86；95%CI: 0.78-0.95（第二次KT）。再次移植的机会也更高，先前的先发制人的KT和先前的移植物存活超过5年。结论：我们的研究突出了KT获取的差异，特别是女性、最年轻的接受者、高危年龄（15-19岁）和有复发风险的疾病。值得注意的是，先发制人的移植和持久的先前移植物提供了再次移植的优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nephrology Dialysis Transplantation 医学-泌尿学与肾脏学

CiteScore

10.10

自引率

4.90%

发文量

1431

审稿时长

1.7 months

期刊介绍： Nephrology Dialysis Transplantation (ndt) is the leading nephrology journal in Europe and renowned worldwide, devoted to original clinical and laboratory research in nephrology, dialysis and transplantation. ndt is an official journal of the [ERA-EDTA](http://www.era-edta.org/) (European Renal Association-European Dialysis and Transplant Association). Published monthly, the journal provides an essential resource for researchers and clinicians throughout the world. All research articles in this journal have undergone peer review. Print ISSN: 0931-0509.