ESPN 51th Annual Meeting

ESPN 2018


 
Kidney Transplantation in young Children: Association between body weight and outcome – a Report from the ESPN/ERA-EDTA Registry
BOEHM MICHAEL 1 BONTHUIS MARJOLEIN 2 HARAMBAT JéRôME 3 AUFRICHT CHRISTOPH 1 JAGER KITTY J 2 GROOTHOFF JAAP 4

1- DIVISION OF PEDIATRIC NEPHROLOGY AND GASTROENTEROLOGY, MEDICAL UNIVERSITY VIENNA, AUSTRIA
2- ESPN/ERA-EDTA REGISTRY AND ERA-EDTA REGISTRY, DEPARTMENT OF MEDICAL INFORMATICS, ACADEMIC MEDICAL CENTER, UNIVERSITY OF AMSTERDAM, AMSTERDAM PUBLIC HEALTH RESEARCH INSTITUTE, AMSTERDAM, THE NETHERLANDS
3- PEDIATRIC NEPHROLOGY UNIT, BORDEAUX UNIVERSITY HOSPITAL, BORDEAUX, FRANCE
4- DEPARTMENT OF PEDIATRIC NEPHROLOGY, EMMA CHILDREN´S HOSPITAL, ACADEMIC MEDICAL CENTER, AMSTERDAM, THE NETHERLANDS
 
Introduction:

Kidney transplantation (Tx) in young children is challenging and requires multidisciplinary expertise. Many centres accept a minimum recipient body weight of 10 kg, but sound evidence-based knowledge is lacking. Therefore, we aimed to evaluate the current practice and outcomes of Tx in Europe.

Material and methods:

We included all patients who started RRT at an age <2.5 years and received a Tx between 2000 and 2015, and for whom body weight at Tx was reported to the ESPN/ERA-EDTA Registry. We categorized weight at Tx into two groups: < 10 or >10 kg. Cox regression analysis was used to evaluate the association between weight at Tx and graft survival. 

Results:

91 (17%) of 537 children (35.6% female) received a Tx at a body weight <10 kg (median: 7.8 kg (IQR: 5.5-8.8)). The sex and primary renal disease distribution was similar to children weighing >10 kg at Tx (median body weight: 13.0 kg (IQR: 11.4-15.3)). We found a significantly higher pre-emptive Tx rate for children < 10 kg (n=15; 16.5%) compared with children >10 kg (n=19; 4.3%) (p<0.001). 13 patients died and 64 lost their graft during follow up. Mortality (<10 kg: 4.4%, >10 kg: 2%), graft loss (<10 kg: 18.9%, >10 kg: 13.5%) and particularly graft loss within the first 3 months was similar in both groups (<10 kg: 41.2%, >10 kg: 46.7%). Body weight at transplantation was not associated with five-year-graft survival (adjusted HR <10 kg vs. ≥ 10 kg: 0.92, 95% CI: 0.62-1.34). 

Conclusions:

 We found no evidence for an increased risk of graft failure or mortality in Tx recipients <10 kg. Our data suggest that Tx is possible in young children. We speculate that the decision for transplantation in young children is influenced by centre experience, local policies or complications of dialysis and primary renal disease.