The effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy

Anneke Kramer, Vianda S. Stel, Ronald B. Geskus, E. Jane Tizard, Enrico Verrina, Franz Schaefer, James G. Heaf, Reinhard Kramar, Leah Krischock, Torbjørn Leivestad, Runólfur Pálsson, Pietro Ravani, Kitty J. Jager

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background. Controversy exists concerning the timing of the first kidney transplantation for children who need to start renal replacement therapy (RRT). Our aim was to estimate the effect of timing of the first transplantation on patient survival in children, for the first time also taking into account the mortality on dialysis before transplantation. Methods. We included 2091 patients who started RRT between the age of 3 and 18 years in the period 1988- 2007, from 13 European renal registries. A multistate model was used to simulate patient survival assuming (i) pre-emptive transplantation, (ii) transplantation after 1 or 2 years on dialysis and (iii) remaining on dialysis. Results. Over the 20-year period, the highest 8-year survival probabilities were achieved in children transplanted pre-emptively {living donor (LD): 95.9% [95% confidence interval (CI): 93.1-98.8], deceased donor (DD): 95.3% (95% CI: 90.9-99.9)} rather than after 2 years of dialysis [LD: 94.2% (95% CI: 91.6-96.8), DD: 93.4% (95% CI: 91.0-95.9)], although these differences were not statistically significant. Conclusions. Even after taking mortality on dialysis into account, the potentially negative effect of postponing transplantation for 1 or 2 years was relatively small and not statistically significant. Therefore, if pre-emptive transplantation is not possible, starting RRT with a short period of dialysis and receiving a transplant thereafter seems an acceptable alternative from the perspective of patient survival.

Original languageEnglish
Pages (from-to)1256-1264
Number of pages9
JournalNephrology Dialysis Transplantation
Volume27
Issue number3
DOIs
Publication statusPublished - May 2012

Fingerprint

Renal Replacement Therapy
Kidney Transplantation
Dialysis
Transplantation
Survival
Confidence Intervals
Living Donors
Tissue Donors
Mortality
Registries
Transplants
Kidney

Keywords

  • Dialysis
  • Epidemiology
  • Kidney transplantation
  • Paediatric nephrology

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

The effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy. / Kramer, Anneke; Stel, Vianda S.; Geskus, Ronald B.; Tizard, E. Jane; Verrina, Enrico; Schaefer, Franz; Heaf, James G.; Kramar, Reinhard; Krischock, Leah; Leivestad, Torbjørn; Pálsson, Runólfur; Ravani, Pietro; Jager, Kitty J.

In: Nephrology Dialysis Transplantation, Vol. 27, No. 3, 05.2012, p. 1256-1264.

Research output: Contribution to journalArticle

Kramer, A, Stel, VS, Geskus, RB, Tizard, EJ, Verrina, E, Schaefer, F, Heaf, JG, Kramar, R, Krischock, L, Leivestad, T, Pálsson, R, Ravani, P & Jager, KJ 2012, 'The effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy', Nephrology Dialysis Transplantation, vol. 27, no. 3, pp. 1256-1264. https://doi.org/10.1093/ndt/gfr493
Kramer, Anneke ; Stel, Vianda S. ; Geskus, Ronald B. ; Tizard, E. Jane ; Verrina, Enrico ; Schaefer, Franz ; Heaf, James G. ; Kramar, Reinhard ; Krischock, Leah ; Leivestad, Torbjørn ; Pálsson, Runólfur ; Ravani, Pietro ; Jager, Kitty J. / The effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy. In: Nephrology Dialysis Transplantation. 2012 ; Vol. 27, No. 3. pp. 1256-1264.
@article{81cb313605c34296bd2310bd6569cf98,
title = "The effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy",
abstract = "Background. Controversy exists concerning the timing of the first kidney transplantation for children who need to start renal replacement therapy (RRT). Our aim was to estimate the effect of timing of the first transplantation on patient survival in children, for the first time also taking into account the mortality on dialysis before transplantation. Methods. We included 2091 patients who started RRT between the age of 3 and 18 years in the period 1988- 2007, from 13 European renal registries. A multistate model was used to simulate patient survival assuming (i) pre-emptive transplantation, (ii) transplantation after 1 or 2 years on dialysis and (iii) remaining on dialysis. Results. Over the 20-year period, the highest 8-year survival probabilities were achieved in children transplanted pre-emptively {living donor (LD): 95.9{\%} [95{\%} confidence interval (CI): 93.1-98.8], deceased donor (DD): 95.3{\%} (95{\%} CI: 90.9-99.9)} rather than after 2 years of dialysis [LD: 94.2{\%} (95{\%} CI: 91.6-96.8), DD: 93.4{\%} (95{\%} CI: 91.0-95.9)], although these differences were not statistically significant. Conclusions. Even after taking mortality on dialysis into account, the potentially negative effect of postponing transplantation for 1 or 2 years was relatively small and not statistically significant. Therefore, if pre-emptive transplantation is not possible, starting RRT with a short period of dialysis and receiving a transplant thereafter seems an acceptable alternative from the perspective of patient survival.",
keywords = "Dialysis, Epidemiology, Kidney transplantation, Paediatric nephrology",
author = "Anneke Kramer and Stel, {Vianda S.} and Geskus, {Ronald B.} and Tizard, {E. Jane} and Enrico Verrina and Franz Schaefer and Heaf, {James G.} and Reinhard Kramar and Leah Krischock and Torbj{\o}rn Leivestad and Run{\'o}lfur P{\'a}lsson and Pietro Ravani and Jager, {Kitty J.}",
year = "2012",
month = "5",
doi = "10.1093/ndt/gfr493",
language = "English",
volume = "27",
pages = "1256--1264",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "Oxford University Press",
number = "3",

}

TY - JOUR

T1 - The effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy

AU - Kramer, Anneke

AU - Stel, Vianda S.

AU - Geskus, Ronald B.

AU - Tizard, E. Jane

AU - Verrina, Enrico

AU - Schaefer, Franz

AU - Heaf, James G.

AU - Kramar, Reinhard

AU - Krischock, Leah

AU - Leivestad, Torbjørn

AU - Pálsson, Runólfur

AU - Ravani, Pietro

AU - Jager, Kitty J.

PY - 2012/5

Y1 - 2012/5

N2 - Background. Controversy exists concerning the timing of the first kidney transplantation for children who need to start renal replacement therapy (RRT). Our aim was to estimate the effect of timing of the first transplantation on patient survival in children, for the first time also taking into account the mortality on dialysis before transplantation. Methods. We included 2091 patients who started RRT between the age of 3 and 18 years in the period 1988- 2007, from 13 European renal registries. A multistate model was used to simulate patient survival assuming (i) pre-emptive transplantation, (ii) transplantation after 1 or 2 years on dialysis and (iii) remaining on dialysis. Results. Over the 20-year period, the highest 8-year survival probabilities were achieved in children transplanted pre-emptively {living donor (LD): 95.9% [95% confidence interval (CI): 93.1-98.8], deceased donor (DD): 95.3% (95% CI: 90.9-99.9)} rather than after 2 years of dialysis [LD: 94.2% (95% CI: 91.6-96.8), DD: 93.4% (95% CI: 91.0-95.9)], although these differences were not statistically significant. Conclusions. Even after taking mortality on dialysis into account, the potentially negative effect of postponing transplantation for 1 or 2 years was relatively small and not statistically significant. Therefore, if pre-emptive transplantation is not possible, starting RRT with a short period of dialysis and receiving a transplant thereafter seems an acceptable alternative from the perspective of patient survival.

AB - Background. Controversy exists concerning the timing of the first kidney transplantation for children who need to start renal replacement therapy (RRT). Our aim was to estimate the effect of timing of the first transplantation on patient survival in children, for the first time also taking into account the mortality on dialysis before transplantation. Methods. We included 2091 patients who started RRT between the age of 3 and 18 years in the period 1988- 2007, from 13 European renal registries. A multistate model was used to simulate patient survival assuming (i) pre-emptive transplantation, (ii) transplantation after 1 or 2 years on dialysis and (iii) remaining on dialysis. Results. Over the 20-year period, the highest 8-year survival probabilities were achieved in children transplanted pre-emptively {living donor (LD): 95.9% [95% confidence interval (CI): 93.1-98.8], deceased donor (DD): 95.3% (95% CI: 90.9-99.9)} rather than after 2 years of dialysis [LD: 94.2% (95% CI: 91.6-96.8), DD: 93.4% (95% CI: 91.0-95.9)], although these differences were not statistically significant. Conclusions. Even after taking mortality on dialysis into account, the potentially negative effect of postponing transplantation for 1 or 2 years was relatively small and not statistically significant. Therefore, if pre-emptive transplantation is not possible, starting RRT with a short period of dialysis and receiving a transplant thereafter seems an acceptable alternative from the perspective of patient survival.

KW - Dialysis

KW - Epidemiology

KW - Kidney transplantation

KW - Paediatric nephrology

UR - http://www.scopus.com/inward/record.url?scp=84861140032&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861140032&partnerID=8YFLogxK

U2 - 10.1093/ndt/gfr493

DO - 10.1093/ndt/gfr493

M3 - Article

C2 - 21865215

AN - SCOPUS:84861140032

VL - 27

SP - 1256

EP - 1264

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

IS - 3

ER -