ESPN 54th Annual Meeting

ESPN 2022


 
DETERMINANTS OF PATIENT SURVIVAL AFTER PAEDIATRIC KIDNEY TRANSPLANTATION: THE EUROTRANSPLANT REGISTRY ANALYSIS
FERRAN COENS 1 NOëL KNOPS 2 INEKE TIEKEN 3 SERGE VOGELAAR 3 JON JIN KIM 4 AGNIESZKA PRYTULA 1

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY AND RHEUMATOLOGY, GHENT UNIVERSITY HOSPITAL, GHENT, BELGIUM
2- DEPARTMENT OF PEDIATRIC NEPHROLOGY, UNIVERSITY HOSPITAL LEUVEN, LEUVEN, BELGIUM
3- EUROTRANSPLANT, LEIDEN, THE NETHERLANDS
4- NOTTINGHAM UNIVERSITY HOSPITAL NHS TRUST, UNITED KINGDOM
 
Introduction:

 We report patient survival and factors associated with time to death after first and sequential paediatric kidney transplantation (KTx).

Material and methods:

Data on patients younger than 18 years at first KTx between 1990 and 2020 were provided by the Eurotransplant Registry. Multivariable Cox-regression models with country-level clustering and time-dependent covariates were applied to identify factors associated with overall patient survival. 

Results:

We included 4528 patients with 5987 grafts with median age at primary KTx 11 years (interquartile range [IQR] 6-14) and median follow-up of 10 years (IQR 4-17). The 10- year mortality after live donor (LD) and deceased donor (DD) KTx performed in 1990-2000 was 4% and 7% as compared to  2% and 4% in KTx performed in 2011-2020.  The 15-year mortality risk after the 1st, 2nd, 3rd and 4th KTx was 9%, 12%, 16% and 26%. The risk of death was lower after live donor (LD) KTx (unadjusted hazard ratio [uHR] 0.53, 95% confidence intervals [CI] 0.40-0.69, log-rank P < 0.001). Time to death was associated with: LD (adjusted hazard ratio [aHR] 0.64, CI 0.46-0.89, P=0.007), ascending year of KTx (aHR 0.98, CI 0.97-0.99, P< 0.001), dialysis after 1st (aHR 4.31, CI 3.35-5.55, P< 0.001), 2nd (aHR 8.37, CI 6.75-10.40, P< 0.001) and 3rd graft failure (aHR 7.51, CI 4.23-13.35, P< 0.001), donor age above 50 years (aHR 1.70, CI 1.12-2.60, P = 0.014), HLA-mismatch equal to 5 (aHR 2.69, CI 1.77-4.10, P<0.001) or 6 (aHR 3.90, CI 3.25-4.68, P<0.001), male recipient-female donor (aHR 1.38, CI 1.20-1.58, P<0.001), female recipient-male donor (aHR 1.16, CI 1.07-1.26, P<0.001) and glomerular kidney disease (aHR 1.20, CI 1.06-1.34, P=0.002). 

Conclusions:

Recipient and donor characteristics are subject to clinical decision making and should be considered at patient counselling and acceptance of organs for KTx.