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Preemptive Kidney Transplantation Is Associated With Transplantation Outcomes in Children: Results From the French
Mathilde Prezelin-Reydit1, Iona Madden2, Marie-Alice Macher3,4
1University of Bordeaux, Institute of Health and Medical Research, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France.
Insights
Preemptive kidney transplantation (PKT) significantly improves graft survival in pediatric patients compared to post-dialysis transplantation. This approach offers better long-term outcomes for children with end-stage kidney disease.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Clinical Outcomes Research
Background:
- Kidney transplantation (KT) is the preferred treatment for pediatric end-stage kidney disease.
- Preemptive kidney transplantation (PKT) involves transplanting before dialysis is required.
- The impact of PKT and dialysis duration on graft survival in children needs evaluation.
Purpose of the Study:
- To assess the effect of preemptive kidney transplantation (PKT) on graft survival.
- To determine the influence of pretransplant dialysis duration on outcomes in pediatric KT recipients.
- To compare graft survival rates between PKT and post-dialysis KT in children.
Main Methods:
- Analysis of first pediatric kidney-only transplantations in France (1993-2012).
- Utilized Cox multivariable models to assess graft failure risk.
- Graft failure defined as death, return to dialysis, or retransplant.
Main Results:
- 1911 pediatric patients included; 19.8% received PKT.
- PKT reduced graft failure hazard by 55% (HR 0.45) compared to post-dialysis KT.
- Benefit of PKT observed regardless of dialysis duration (<6 months) or modality.
Conclusions:
- Preemptive kidney transplantation (PKT) in pediatric patients leads to superior graft survival.
- PKT is associated with better outcomes even when initiated before 6 months of dialysis.
- PKT should be considered the primary treatment option for children with end-stage kidney disease.
Background:
Kidney transplantation (KT) is the optimal treatment for children with end-stage kidney disease. The aim of this study was to evaluate the impact of preemptive kidney transplantation (PKT) and of pretransplant dialysis duration on graft survival among French pediatric kidney transplant recipients.
Methods:
We analyzed all first pediatric kidney-only transplantations performed in France between 1993 and 2012. A Cox multivariable model was used to investigate the association of PKT and pretransplant dialysis time with the hazard of graft failure defined as death, return to dialysis, or retransplant, whichever occurred first.
Results:
Patients (n = 1911) were included, of which 380 (19.8%) received a PKT. Median time of follow-up was 7.0 y. PKT was associated with a 55% reduction of the hazard of graft failure at any time after KT compared with patients transplanted after dialysis (hazard ratio, 0.45; 95% confidence interval, 0.33-0.62), after adjustment for recipient sex and age, primary kidney disease, donor age and type (living or deceased donor), number of HLA mismatches, cold ischemia time, and year of transplantation. A reduction of the hazard of graft failure was found in PKT whatever the compared duration of dialysis, even when <6 mo and whatever the dialysis modality. Results were similar in multiple sensitivity analyses.
Conclusions:
In France, PKT among pediatric patients is associated with a better graft survival when compared with KT after dialysis, even when <6 mo. Based on these findings, we suggest that PKT should be considered as the treatment of choice for children with end-stage kidney disease.
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