Disparities in Policies, Practices and Rates of Pediatric Kidney Transplantation in Europe

Abstract

We aimed to provide an overview of kidney allocation policies related to children and pediatric kidney transplantation (KTx) practices and rates in Europe, and to study factors associated with KTx rates. A survey was distributed among renal registry representatives in 38 European countries. Additional data were obtained from the ESPN/ERA-EDTA and ERA-EDTA registries. Thirty-two countries (84%) responded. The median incidence rate of pediatric KTx was 5.7 (range 0À13.5) per million children (pmc). A median proportion of 17% (interquartile range 2À29) of KTx was performed preemptively, while the median proportion of living donor KTx was 43% (interquartile range 10À52). The median percentage of children on renal replacement therapy (RRT) with a functioning graft was 62%. The level of pediatric prioritization was associated with a decreased waiting time for deceased donor KTx, an increased pediatric KTx rate, and a lower proportion of living donor KTx. The rates of pediatric KTx, distribution of donor source and time on waiting list vary considerably between European countries.The lack of harmonization in kidney allocation to children raises medical and ethical issues. Harmonization of pediatric allocation policies should be prioritized.

Inequality in pediatric kidney transplantation in Brazil

“…Children in both the North and the Midwest are disadvantaged when compared to children enrolled in others regions. This geographic inequality phenomenon has already been observed in the US and in Europe [5,14,17]. Multivariable analysis confirmed the disadvantage of the North/Midwest and that age and GDP also influenced the probability of receiving a deceased donor kidney transplant.…”

Demographics of paediatric renal replacement therapy in Europe: a report of the ESPN/ERA–EDTA registry

“…The international variation in RRT rates may be explained, to some extent, by random variation caused by the rarity of paediatric ESRD, by variation in the occurrence of different causes of renal failure in each country (e.g. the relatively high incidence of Finnish-type nephropathy in Finland) and by economic disparities between countries, as has been shown for PD prevalence [17] and transplantation rate [18]. Furthermore, the higher incidence in the USA has been attributed to an earlier start on RRT [1,19].…”

Optimising care for children with kidney disease

“…Although kidney transplant rates have been included in the model, because of queue theory [6] these will not necessarily reflect the known marked differences in the time children wait for a transplant. Waiting times are known to differ markedly between countries and have been shown to be determined by non-medical factors [7,8]. For example, a child will wait 6 months for a transplant in France compared with 15 months in the UK, 26 months in the Netherlands and 30 months in Russia [7].…”

“…Waiting times are known to differ markedly between countries and have been shown to be determined by non-medical factors [7,8]. For example, a child will wait 6 months for a transplant in France compared with 15 months in the UK, 26 months in the Netherlands and 30 months in Russia [7]. This is relevant because kidney transplantation confers a survival advantage over remaining on dialysis: once children have survived the first few months of kidney transplantation their mortality risk is at least half of what it would have been had they stayed on dialysis [9].…”