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 af dette arbejde

    Publikation: Bidrag til tidsskriftArtikelForskningpeer review


    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.

    Sider (fra-til)1256-1264
    Antal sider9
    TidsskriftNephrology Dialysis Transplantation
    Udgave nummer3
    StatusUdgivet - 1 maj 2012


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