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Should children receive a kidney transplant before 2 years of age?
Sarah J Kizilbash1, Michael D Evans2, David M Vock3
1Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
Insights
Kidney transplantation before age 2 improves survival for children with kidney failure. Early kidney transplant (before 2 years) offers better patient survival and less dialysis compared to waiting until age 2.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Clinical Outcomes Research
Background:
- Optimal timing for kidney transplantation in infants and toddlers with kidney failure remains uncertain.
- This study compares patient survival for kidney transplantation before 2 years of age versus remaining on the waitlist until 2 years or older.
Purpose of the Study:
- To evaluate patient survival associated with early kidney transplantation (before 2 years of age).
- To compare outcomes of early kidney transplantation versus continued waitlisting for pediatric kidney failure patients.
Main Methods:
- Utilized the Scientific Registry of Transplant Recipients (SRTR) for data from 2000-2020.
- Identified children added to the deceased-donor waitlist before age 2.
- Employed sequential Cox regression to analyze patient survival and defined dialysis-free time for comparison.
Main Results:
- Children transplanted before age 2 showed higher long-term patient survival (>12 months) compared to controls on the waitlist.
- Both deceased-donor and living-donor recipients under age 2 experienced significantly improved survival rates.
- Five-year dialysis-free survival was substantially higher for early transplant recipients (0.59 years for deceased-donor, 1.84 years for living-donor).
Conclusions:
- Kidney transplantation in children under 2 years of age is linked to better patient survival.
- Early kidney transplantation significantly reduces overall dialysis exposure in pediatric patients with kidney failure.
- Transplanting infants and toddlers before age 2 is associated with improved outcomes compared to prolonged waitlisting.
Background:
The optimal age of kidney transplantation for infants and toddlers with kidney failure is unclear. We aimed to evaluate the patient survival associated with kidney transplantation before 2 years of age versus remaining on the waitlist until ≥2 years.
Method:
We used the Scientific Registry of Transplant Recipients to identify all children added to the deceased-donor waitlist before 2 years of age between 1/1/2000 and 4/30/2020. For each case aged <2 years at transplant, we created a control group comprising all candidates on the waitlist on the case's transplant date. Patient survival was evaluated using sequential Cox regression. Dialysis-free time was defined as graft survival time for cases and the sum of dialysis-free time on the waitlist and graft survival time for controls.
Results:
We observed similar patient survival for posttransplant periods 0-3 and 4-12 months but higher survival for period >12 months for <2-year decreased-donor recipients (aHR: 0.32; 95% CI: 0.13-0.78; p = .01) compared with controls. Similarly, patient survival was higher for <2-year living-donor recipients for posttransplant period >12 months (aHR: 0.21; 95% CI: 0.06-0.73; p = .01). The 5-year dialysis-free survival was higher for <2-year deceased- (difference: 0.59 years; 95% CI: 0.23-0.93) and living-donor (difference: 1.84 years; 95% CI: 1.31-2.25) recipients.
Conclusion:
Kidney transplantation in children <2 years of age is associated with improved patient survival and reduced dialysis exposure compared with remaining on the waitlist until ≥2 years.
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