Ferran Coens, Belgium has been granted the IPTA Scientific Congress Award
Retransplantation outcomes in paediatric kidney transplant recipients- the Eurotransplant experience
Ferran Coens1, Noël Knops2, Ineke van Gremberghe3, Ineke Tieken5, Serge Vogelaar5, Kim Jon Jin4, Agnieszka Prytula1.
1Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium; 2Department of Pediatric Nephrology, University Hospital Leuven, Leuven, Belgium; 3Biostatistics Unit, Ghent University, Ghent, Belgium; 4Department of Paediatric Nephrology, Nottingham Children's Hospital, Nottingham, United Kingdom; 5Eurotransplant, Leiden, Netherlands
Introduction: The aim of this study was to analyse differences in graft- and patient survival after the first and sequential kidney transplantation (KT) according to donor source in the Eurotransplant countries.
Materials and methods: All patients younger than 18 years at the time of their 1st KT between 1990 and 2020 were included. Cumulative incidence functions and Gray’s tests were used to analyse the incidence of graft failure (GF) with the competing risk of death with functioning graft and the incidence of death after KT in patients who underwent living donor (LD) vs. deceased donor (DD) KT. Multivariable Cox-regression with patient level clustering and time-dependent covariates was used to identify factors associated with death-censored graft survival and overall patient survival (OS) after KT.
Results: We included 4528 patients (5987 1st and sequential KT) with median age at 1st KT 11 years (y) (interquartile range [IQR], 6-14 y) and median follow-up of 14 y (IQR, 7-22 y). The incidence of graft failure and OS after DD KT vs. LD KT can be found in the attached graphs. The incidence of GF was lower after LD as compared to DD KT after 1st (P < 0.001), 2nd (P < 0.001), 3rd (P = 0.004) but not ≥4th (P = 0.799) KT. The risk of death after KT was significantly lower in LD KT recipients compared to DD after 1st (P < 0.001), but not after 2nd (P = 0.261), 3rd (P = 0.912) and ≥4th KT (P = 0.814). After adjusting for recipient, donor and transplant characteristics, sequential grafts, increasing number of HLA-mismatches, increasing donor age and panel reactive antibodies (PRA) > 0 % were significantly associated with an increased risk of GF. LD KT, male gender and more recent year of transplantation were associated with a lower risk of GF. The graft survival benefit of having a LD KT over DD decreased over time. Whilst 2nd KT, increasing number of HLA-mismatches and increasing donor age were significantly associated with a higher risk of death, more recent year of transplantation and LD KT were associated with a lower risk of death.
Conclusion: LD KT is associated with less graft failure and higher OS compared to DD KT recipients and it should be considered as the first choice at 1st paediatric and sequential KT
