ESPN 50th Annual Meeting

ESPN 2017


 
PRE-EMPTIVE KIDNEY TRANSPLANTATION IS ASSOCIATED WITH IMPROVED GRAFT SURVIVAL IN CHILDREN: DATA FROM THE FRENCH RENAL REGISTRY
MATHILDE REYDIT 1 RéMI SALOMON 2 MARIE-ALICE MACHER 3 BRUNO RANCHIN 4 JULIEN HOGAN 5 GWENAELLE ROUSSEY-KESLER 6 ANNIE LAHOCHE 7 FLORENTINE GARAIX 8 STEPHANE DECRAMER 9 OLIVIER DUNAND 10 MARC FILA 11 TIM ULINSKI 12 ISABELLE VRILLON 13 ARIANE ZALOSZYC 14 ETIENNE BERARD 15 KAREN LEFFONDRé 16 JEROME HARAMBAT 1

1- BORDEAUX UNIVERSITY HOSPITAL
2- NECKER UNIVERSITY HOSPITAL
3- AGENCE DE LA BIOMéDECINE
4- LYON UNIVERSITY HOSPITAL
5- ROBERT DEBRé UNIVERSITY HOSPITAL
6- NANTES UNIVERSITY HOSPITAL
7- LILLE UNIVERSITY HOSPITAL
8- MARSEILLE UNIVERSITY HOSPITAL
9- TOULOUSE UNIVERSITY HOSPITAL
10- LA RéUNION UNIVERSITY HOSPITAL
11- MONTPELLIER UNIVERSITY HOSPITAL
12- TROUSEAU UNIVERSITY HOSPITAL
13- NANCY UNIVERSITY HOSPITAL
14- STRASBOURG UNIVERSITY HOSPITAL
15- NICE UNIVERSITY HOSPITAL
16- UNIVERSITY OF BORDEAUX INSERM U1219
 
Introduction:

Kidney transplantation (KT) is the treatment of choice for end-stage renal disease. Preemptive KT is considered to be the optimal treatment of ESRD particularly in children but reports on the results of pediatric preemptive KT are scarce. The objective of this study was to evaluate the impact of preemptive KT on the risk of graft failure in children with ESRD.

Material and methods:

We analyzed all first kidney transplants performed in children <19 years in France between 1995 and 2013. A Cox multivariable model with competing risk analysis was used to study the impact of preemptive KT on the hazard of graft failure defined as return to dialysis, retransplant, or death, whichever occurred first.

Results:

A total of 1920 pediatric patients were included, of whom 387 (20.2%) received a preemptive KT. Median time of follow-up was 7 years. At 10 years post transplant, graft survival was 85.2% in preemptive KT and 67.1% in non preemptive KT (p<0.001). After adjustment for recipient age and sex, primary kidney disease, donor type (living or deceased donor), donor age, HLA mismatches, and cold ischemia time, preemptive KT was associated with a 45% reduction in the hazard of graft failure when compared with dialysis prior to KT (HR 0.55; 95%CI 0.41-0.73; p<0.001). Patient survival was not significantly influenced by preemptive KT. The impact of preemptive KT on graft failure risk was greater among deceased donor transplant recipients (HR 0.52; 95%CI 0.37-0.72) than among living donor kidney recipients (HR 0.67; 95% 0.31-1.25). Pretransplant dialysis was associated with an increased hazard of graft failure, whatever the duration of dialysis.

Conclusions:

Preemptive KT in children is associated with a lower risk of graft failure than KT performed after the initiation of dialysis, and should be promoted when feasible.