ESPN 51th Annual Meeting

ESPN 2018


 
How to improve access to preemptive kidney transplantation in children?
CYRIELLE PARMENTIER 1 CECILE COUCHOUD 2 MARIE-ALICE MACHER 2 JULIEN HOGAN 3 MATHILDE LASSALLE 2

1- HOPITAL TROUSSEAU, APHP, PARIS, FRANCE
2- REIN REGISTRY, AGENCE DE LA BIOMEDECINE, FRANCE
3- HOPITAL ROBERT-DEBRE, APHP, PARIS, FRANCE
 
Introduction:

Kidney transplantation is the renal replacement modality (RRT) of choice for patients with end-stage renal disease (ESRD). When possible, transplantation should be performed preemptively to avoid the increased morbidity and mortality associated with dialysis. We hypothesize that a better detection of patients may improve access to PTx. Thus, this study aims at comparing patients’ care before RRT initiation between patients transplanted preemptively (PTx) or not.

Material and methods:

We included all 540 patients who started RRT, before 18 years old, between 2010 and 2016 and were transplanted before December 31 2017. To study pre-RRT care, we design a case-control study within our cohort including patients suitable for PTx: all 125 PTx and 137 matched controls, using a propensity score, selected by: age, sex, primary renal diseases, donor type, ease of graft access index, country of birth. Healthcare use during the 18 months prior to RRT initiation was extracted from the French National Health Insurance database.

Results:

Annual PTx incidence was 1.45 per million age-related population (pmarp). If all patients suitable for PTx were transplanted prior to dialysis, this would increase to 2.19 pmarp. We selected 262 patients in our case-control study as suitable for PTx (mean age: 12.3 years, 67% male and 56% urological abnormalities). Living donor rate still differ between patients starting on dialysis (24%) and PTx patients (41%) (p = 0.004). 18 months before RRT initiation, 74 patients starting on dialysis (54%) vs 97 (77%) PTx received a specific oral treatment for CKD. The incidence of hospitalization by patient, within the 6 months before RRT initiation, was 1.9 (vs 0.8) in conventional hospitalization and 1.92 (vs 2.33) in day hospital, in dialysis patients vs PTx, respectively.

Conclusions:

This study demonstrates that a significant part of pediatric patients starting on dialysis as first RRT modality would have been suitable candidates for PTx. An earlier management of patients with chronic kidney disease may result in increasing access to preemptive transplantation in children.