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

IF 4.8 2区医学 Q1 TRANSPLANTATION

Nephrology Dialysis Transplantation Pub Date : 2025-02-12 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: 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 15-19 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 prior pre-emptive KT and previous graft survival exceeding five 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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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.