ESPN 50th Annual Meeting

ESPN 2017


 
IMPROVED RENAL ALLOGRAFT SURVIVAL FOR PRE-EMPTIVE PAEDIATRIC RENAL TRANSPLANT RECIPIENTS
MATKO MARLAIS 1 KATE MARTIN 2 STEPHEN MARKS 3

1- UCL GREAT ORMOND STREET INSTITUTE OF CHILD HEALTH
2- NHS BLOOD AND TRANSPLANT
3- GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST
 
Introduction:

The aim of this study was to investigate whether being on dialysis (peritoneal dialysis or haemodialysis) at the time of renal transplantation affected patient or renal allograft survival in paediatric renal transplant recipients (pRTR).

Material and methods:

Data were obtained from the UK Transplant Registry (NHS Blood and Transplant) on all children (aged <18 years) who received a kidney only transplant between 1 January 2000 and 31 December 2015.  Baseline demographic data were collected, including dialysis modality at the time of renal transplantation (none vs peritoneal dialysis vs haemodialysis).  Kaplan-Meier estimates of 1 and 5-year patient and renal allograft survival were calculated, as well as Cox regression modelling accounting for donor type.

Results:

2,038 pRTR were analysed: 607 (30%) were pre-emptively transplanted, 789 (39%) and 642 (32%) were on peritoneal dialysis and haemodialysis, respectively at the time of transplantation. 5-year renal allograft survival was significantly better in the pre-emptively transplanted group (90.6%) compared to those on peritoneal dialysis and haemodialysis (86.4% and 85.7% respectively; p = 0.02). There was no significant difference in 5-year patient survival or in 1-year patient or renal allograft survival across the groups.  After accounting for donor type, we found a significantly lower hazard of 5-year renal allograft failure in pre-emptively transplanted children (HR 0.742, p = 0.05).

Conclusions:

Children who are pre-emptively transplanted have improved 5-year renal allograft survival, compared to children on haemodialysis or peritoneal dialysis at the time of transplantation. This provides further evidence to support attempts to achieve pre-emptive renal transplantation wherever possible in children and avoid dialysis.