Cost analysis of substitutive renal therapies in children

Camargo, Maria Fernanda Carvalho de; Barbosa, Klênio; Fetter, Seiji Kumon; Bastos, Ana; Feltran, Luciana de Santis; Nogueira, Paulo César Koch

doi:10.1016/j.jpedp.2017.08.004

Cited by 4 publications

(6 citation statements)

References 24 publications

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“…Kidney transplantation is the optimal treatment for end‐stage renal disease, providing children with improved outcomes compared to dialysis 1‐3 . Despite advances in care, immunosuppression causes significant morbidity in pediatric transplant patients including risk for infection while only providing partial protection against allograft rejection 4 .…”

Section: Introductionmentioning

confidence: 99%

Relationship between antithymocyte globulin, T cell phenotypes, and clinical outcomes in pediatric kidney transplantation

Shaw

Lee

Chan

et al. 2021

American Journal of Transplantation

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Depletional induction using antithymocyte globulin (ATG) reduces rates of acute rejection in adult kidney transplant recipients, yet little is known about its effects in children. Using a longitudinal cohort of 103 patients in the Immune Development in Pediatric Transplant (IMPACT) study, we compared T cell phenotypes after ATG or non‐ATG induction. We examined the effects of ATG on the early clinical outcomes of alloimmune events (development of de novo donor specific antibody and/or biopsy proven rejection) and infection events (viremia/viral infections). Long‐term patient and graft outcomes were examined using the Scientific Registry of Transplant Recipients. After ATG induction, although absolute counts of CD4 and CD8 T cells were lower, patients had higher percentages of CD4 and CD8 memory T cells with a concomitant decrease in frequency of naïve T cells compared to non‐ATG induction. In adjusted and unadjusted models, ATG induction was associated with increased early event‐free survival, with no difference in long‐term patient or allograft survival. Decreased CD4+ naïve and increased CD4+ effector memory T cell frequencies were associated with improved clinical outcomes. Though immunologic parameters are drastically altered with ATG induction, long‐term clinical benefits remain unclear in pediatric patients.

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Section: Introductionmentioning

confidence: 99%

Relationship between antithymocyte globulin, T cell phenotypes, and clinical outcomes in pediatric kidney transplantation

Shaw

Lee

Chan

et al. 2021

American Journal of Transplantation

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“…Large disparities exist in access to pediatric kidney transplantation across Europe, whereas graft survival rates are relatively similar. As kidney transplantation is associated with lower morbidity and mortality, and is more cost-effective 14,15 compared with dialysis, 2 substantial health gains could be achieved by improving access to kidney transplantation, especially in low-and middle-income countries. Strategies advocated to promote early kidney transplantation include the introduction of living donation programs and the adoption of a pediatric priority policy.…”

Section: Discussionmentioning

confidence: 99%

“…Although morbidity and mortality are much higher on dialysis than after kidney transplantation, 2 there is some evidence that a short period of dialysis prior to transplantation has little effect on patient survival as compared with pre-emptive transplantation. 5,13 Nevertheless, given the better quality of life, cognitive development, and growth post-transplant, 2 and taking into account the higher cost-effectiveness associated with transplantation compared with dialysis, 14,15 lower income countries in Europe would benefit financially, and in "healthy" life-years gained, by transplanting these children sooner. Also, for some higher income countries in Europe transplant activities could be improved, as the access to transplantation is lower compared to other high-income countries.…”

Section: The Effect Of Macroeconomics On Access To Kidney Transplantationmentioning

confidence: 99%

Results in the ESPN/ERA-EDTA Registry suggest disparities in access to kidney transplantation but little variation in graft survival of children across Europe

Bonthuis

Cuperus

Chesnaye

et al. 2020

Kidney International

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…ESRD is characterized by severe irreversible renal injury and a low GFR of below 15 mL/min/1.73 m 2 1 . The disease represents a major public health issue with implications for morbimortality in the affected population, accompanied by a high economic burden 2 . Therapeutic options include dialysis modalities and kidney transplantation, with the last one proving the most effective treatment approach for patients.…”

Section: Introductionmentioning

confidence: 99%

Acute rejection in pediatric renal transplantation: Retrospective study of epidemiology, risk factors, and impact on renal function

Pereira

Tedesco‐Silva

Nogueira

2020

Pediatric Transplantation

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AR is a major relevant and challenging topic in pediatric kidney transplantation. Our objective was to evaluate cumulative incidence of AR in pediatric kidney transplant patient, risk factors for this outcome, and impact on allograft function and survival. A retrospective cohort including pediatric patients that underwent kidney transplantation between 2011 and 2015 was designed. Risk factors for AR were tested by competing risk analysis. To estimate its impact, graft survival and difference in GFR were evaluated. Two hundred thirty patients were included. As a whole, the incidence of AR episodes was 0.16 (95% CI = 0.12‐0.20) per person‐year of follow‐up. And cumulative incidence of AR was 23% in 1 year and 39% in 5 years. Risk factors for AR were number of MM (SHR 1.36 CI 1.14‐1.63 P = .001); ISS with CSA, PRED, and AZA (SHR 2.22 CI 1.14‐4.33 P = .018); DGF (SHR 2.49 CI 1.57‐3.93 P < .001); CMV infection (SHR 5.52 CI 2.27‐11.0 P < .001); and poor adherence (SHR 2.28 CI 1.70‐4.66 P < .001). Death‐censored graft survival in 1 and 5 years was 92.5% and 72.1%. Risk factors for graft loss were number of MM (HR 1.51 CI 1.07‐2.13 P = .01), >12 years (HR 2.66 CI 1.07‐6.59 P = .03), and PRA 1%‐50% (HR 2.67 CI 1.24‐5.73 P = .01). Although occurrence of AR did not influence 5‐year graft survival, it negatively impacted GFR. AR was frequent in patients assessed and associated with number of MM, ISS regimen, DGF, CMV infection, and poor adherence, and had deleterious effect on GFR.

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Cost analysis of substitutive renal therapies in children

Cited by 4 publications

References 24 publications

Relationship between antithymocyte globulin, T cell phenotypes, and clinical outcomes in pediatric kidney transplantation

Relationship between antithymocyte globulin, T cell phenotypes, and clinical outcomes in pediatric kidney transplantation

Results in the ESPN/ERA-EDTA Registry suggest disparities in access to kidney transplantation but little variation in graft survival of children across Europe

Acute rejection in pediatric renal transplantation: Retrospective study of epidemiology, risk factors, and impact on renal function

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