ESPN 53rd Annual Meeting

ESPN 2021


 
Transplantation in childhood and re-transplantation in adulthood: results from the ERA-EDTA Registry.
EVGENIA PREKA 1 MARJOLEIN BONTHUIS 1 JEROME HARAMBAT 2 ENRICO VIDAL 3 LESLEY REES 4 KITTY J JAGER 1

1- EUROPEAN SOCIETY FOR PEDIATRIC NEPHROLOGY/ EUROPEAN RENAL ASSOCIATION-EUROPEAN DIALYSIS AND TRANSPLANT ASSOCIATION REGISTRY, AMSTERDAM UMC, UNIVERSITY OF AMSTERDAM, DEPARTMENT OF MEDICAL INFORMATICS, AMSTERDAM PUBLIC HEALTH RESEARCH INSTITUTE, AMSTERDAM, THE NETHERLANDS
2- PEDIATRIC NEPHROLOGY UNIT, BORDEAUX UNIVERSITY HOSPITAL, BORDEAUX, FRANCE
3- DIVISION OF PEDIATRICS, DEPARTMENT OF MEDICINE, UNIVERSITY OF UDINE, UDINE, ITALY
4- PEDIATRIC NEPHROLOGY, UCL GREAT ORMOND STREET INSTITUTE OF CHILD HEALTH, UCL, LONDON, UNITED KINGDOM
 
Introduction:

Over 25% of pediatric kidney transplants (KTs) are lost within 7 years necessitating return to dialysis or retransplantation. Knowledge regarding the long-term outcomes after pediatric retransplantation is limited. Using ERA-EDTA Registry data, we investigated kidney retransplantation outcomes from childhood into adulthood.

Material and methods:

Patients on kidney replacement therapy (KRT) between August 1979 and December 2016 were studied.Multivariable Cox regression models were applied to study access to KT.Death-censored graft survival was analyzed and retransplantation outcomes were assessed using cumulative incidence competing risk analysis.

Results:

A total of 4871, 1126 and 259 children having received at least one, two and three KTs, respectively, were included. Median age at first, second and third KT was 12.6, 20.0 and 24.9 years old, respectively and median follow-up was 23.2 years. Starting KRT at younger age (0-4 years old) was associated with a lower access to first KT [adjusted HR (aHR) 0.45; 95%CI 0.41-0.49].Children receiving their first KT between 10-14 years old had lower graft survival rates compared to other age groups. Patients with recurrent diseases showed a lower access to KT regarding their first and second KT (aHR 0.79; 95%CI 0.73-0.86 and aHR 0.85; 95%CI 0.73-0.99, respectively).Regarding access to subsequent KT according to the type of previous KT, the likelihood of receiving a second KT was significantly lower when first KT was from a deceased donor (aHR, 0.79; 95%CI 0.68-0.92). The 10-year graft survival rate was 63.1%, 51.3% and 46.4% for the first, second and third KT, respectively, and graft survival was significantly better for first and second KT with living donor kidneys.

Conclusions:

First KT had better overall survival compared to subsequent KTs. Survival rates are better for living donor recipients for first and second KT but comparable to DD for third KT. Having received a DD as first KT decreases the chances for further KTs.