G464(P) Twenty years of kidney transplantation in a national programme

Abstract

AimTo review the demographics and outcomes of kidney transplantation in Northern Ireland over two decades.MethodsAll kidney transplants performed from 1995–2016 were included. Donor and recipient demographics and transplant details are recorded at the time of transplantation. Recipient and donor outcomes are collected prospectively.ResultsThere were 78 transplants performed during the study period; 61% of recipients were male. The median age was 12 years. The median duration of pre-transplant renal replacement therapy was 14 months. Eighteen patients were transplanted preemptively; 50% of transplants performed since 2010 have been pre-emptive.Kidneys donated after brain death were the organ source in 65% of cases. Since 2010, the majority of transplants performed have been from living donors. The median donor age was 29 years and the median number of HLA mismatches was two. The ischaemic time ranged from 143–2785 minutes (median 1143 min).Median follow up time was 9.6 years. Discharge creatinine was available for 42 patients with a median of 54 mmol/L. One and two years after transplant, the median creatinine was 76 mmol/L and 87 mmol/L respectively.The median graft survival was 84.5 months. There were 22 cases of death-censored graft loss in the study period. In five, graft loss was secondary to early technical problems; these all occurred between 1995 and 2005. In the other 17, grafts functioned for 5–18 years prior to failure. In multivariate analysis, recipient age, donor age and era of transplantation were associated with graft survival.Three deaths occurred in the follow up period. Two patients died within the first month and a third died from post-transplant lymphoproliferative disorder 17 years after transplantation.ConclusionOutcomes after paediatric kidney transplantation in Northern Ireland have improved over the past twenty years. There have been no early graft losses or deaths in the past decade. The expansion of the living donor programme means that 50% of children are now transplanted pre-emptively.