Kidney transplantation without prior dialysis in children: the Eurotransplant experience

Am J Transplant. 2006 Aug;6(8):1858-64. doi: 10.1111/j.1600-6143.2006.01405.x. Epub 2006 Jun 9.

Abstract

Kidney transplantation without prior dialysis may prevent dialysis-associated morbidity. We analyzed the outcome of 1113 first kidney transplants in children performed between 1990 and 2000 in the Eurotransplant community. Enlistment for a deceased donor kidney before start of dialysis (127/895, 14%) made dialysis redundant in 55% of cases. Mean residual creatinine clearance at transplantation of these patients was 8 mL/min/1.73 m(2). Pre-emptive transplantations of deceased donor kidneys showed less acute rejections (52% vs. 37% rejection-free at 3 years, p = 0.039), compared to transplantations following dialysis. The difference in graft survival between non-dialyzed and dialyzed patients (82% vs. 69% at 6 year) did not reach statistical significance (p = 0.055). No differences were noted after living donor transplantation. Multivariate analysis showed that the period of transplantation was the strongest predictor of graft survival (p < 0.001). Congenital structural abnormalities such as primary kidney disease predominated in nondialyzed patients as compared to dialyzed patients (p < 0.001); this factor did not influence graft survival. Based on our conclusion that pre-emptive transplantation is at least as good as post-dialysis transplantation, as well as on quality of life arguments, we recommend to consider pre-emptive transplantation in children with end-stage renal failure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Europe / epidemiology
  • Follow-Up Studies
  • Graft Survival / drug effects
  • Humans
  • Hypertension
  • Immunosuppressive Agents / pharmacology
  • Kidney Transplantation / statistics & numerical data*
  • Renal Dialysis*
  • Survival Rate
  • Time Factors

Substances

  • Immunosuppressive Agents