Access to kidney transplantation and re-Transplantation from childhood to adulthood : Long-Term data from the ERA Registry
(2025) In Nephrology Dialysis Transplantation 40(8). p.1580-1589- Abstract
Background and hypothesis Knowledge regarding access to first kidney transplantation (KT) and subsequent KT in patients commencing kidney replacement therapy (KRT) in childhood is limited. Methods Using European Renal Association (ERA) Registry data, we investigated European patients who started KRT below 20 years of age between 1978 and 2019. Access and determinants to first, second, and third KT were assessed using multivariable Cox regression. Results Totals of 12 623, 4077, and 1186 patients were included while awaiting first, second, and third KT, at median ages of 13.8 (IQR: 7.5-17.4), 20.9 (IQR: 16.5-26.1), and 26.6 (IQR: 20.3-32.8) years, respectively. During the study period, overall access was 87.8%, 72.7%, and 60.5% for... (More)
Background and hypothesis Knowledge regarding access to first kidney transplantation (KT) and subsequent KT in patients commencing kidney replacement therapy (KRT) in childhood is limited. Methods Using European Renal Association (ERA) Registry data, we investigated European patients who started KRT below 20 years of age between 1978 and 2019. Access and determinants to first, second, and third KT were assessed using multivariable Cox regression. Results Totals of 12 623, 4077, and 1186 patients were included while awaiting first, second, and third KT, at median ages of 13.8 (IQR: 7.5-17.4), 20.9 (IQR: 16.5-26.1), and 26.6 (IQR: 20.3-32.8) years, respectively. During the study period, overall access was 87.8%, 72.7%, and 60.5% for first, second, and third KT, respectively, and median time to each KT was 0.9 (IQR: 0.2-2.1), 1.9 (0.6-4.5), and 2.6 (IQR: 1.0-5.3) years. Younger age at KRT initiation (aHR 0-4 vs. 10-14 years: 0.54; 95%CI: 0.51-0.57) and female sex (HR: 0.94; 95%CI: 0.90-0.98) were associated with lower access to first KT. KT candidates between 15 and 19 years had lower access to first and second KT (aHR: 0.69; 95%CI: 0.66-0.73, and aHR: 0.70; 95%CI: 0.61-0.81) compared to 10-14 year-olds. Compared to CAKUT, glomerulonephritis patients had lower access to KT (aHR: 0.75; 95%CI: 0.71-0.80 for first, aHR: 0.89; 95%CI: 0.81-0.98 for second, and aHR: 0.80; 95%CI: 0.66-0.97 for third KT). Similarly, patients with primary renal diseases with high risk of recurrence, had lower chances of receiving a first and second KT (aHR: 0.80; 95%CI: 0.76-0.85 for first, aHR: 0.86; 95%CI: 0.78-0.95 for second KT). Access to re-Transplantation was also higher with previous pre-emptive KT and previous graft survival exceeding 5 years. Conclusion Our study highlights KT access disparities particularly for females, the youngest recipients, high-risk age (15-19 years), and diseases with recurrence risk. Notably, pre-emptive transplants and enduring previous grafts offer advantages regarding re-Transplantation.
(Less)
- author
- Preka, Evgenia
; Bonthuis, Marjolein
; Marks, Stephen D.
; Kramer, Anneke
; De Vries, Aiko P.J.
; Sørensen, Søren S.
; Bakkaloǧlu, Sevcan A.
; Bistrup, Claus
; Jahnukainen, Timo
; Rodriguez Arévalo, Olga L.
; Buchwinkler, Lukas
; Segelmark, Mårten
LU
; Sanchez, J. Emilio
; Arnol, Miha
; Ordóñez-Álvarez, Flor A.
; De La Cerda-Ojeda, Francisco
; Plumb, Lucy A.
; Methven, Shona
; Palsson, Runolfur
; Lundgren, Torbjörn
; Ríos, Héctor
; Ortiz, Alberto
; Stel, Vianda S.
; Harambat, Jerome
and Jager, Kitty J.
(Less) - organization
- publishing date
- 2025-08-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- epidemiology, high-risk age window, kidney transplantation, paediatric, re-Transplantation
- in
- Nephrology Dialysis Transplantation
- volume
- 40
- issue
- 8
- pages
- 10 pages
- publisher
- Oxford University Press
- external identifiers
-
- pmid:39938931
- scopus:105012386641
- ISSN
- 0931-0509
- DOI
- 10.1093/ndt/gfaf025
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2025 The Author(s).
- id
- 11b5c61c-4cdc-48b5-abfd-30d793df433b
- date added to LUP
- 2025-12-04 12:59:33
- date last changed
- 2026-01-01 23:37:31
@article{11b5c61c-4cdc-48b5-abfd-30d793df433b,
abstract = {{<p>Background and hypothesis Knowledge regarding access to first kidney transplantation (KT) and subsequent KT in patients commencing kidney replacement therapy (KRT) in childhood is limited. Methods Using European Renal Association (ERA) Registry data, we investigated European patients who started KRT below 20 years of age between 1978 and 2019. Access and determinants to first, second, and third KT were assessed using multivariable Cox regression. Results Totals of 12 623, 4077, and 1186 patients were included while awaiting first, second, and third KT, at median ages of 13.8 (IQR: 7.5-17.4), 20.9 (IQR: 16.5-26.1), and 26.6 (IQR: 20.3-32.8) years, respectively. During the study period, overall access was 87.8%, 72.7%, and 60.5% for first, second, and third KT, respectively, and median time to each KT was 0.9 (IQR: 0.2-2.1), 1.9 (0.6-4.5), and 2.6 (IQR: 1.0-5.3) years. Younger age at KRT initiation (aHR 0-4 vs. 10-14 years: 0.54; 95%CI: 0.51-0.57) and female sex (HR: 0.94; 95%CI: 0.90-0.98) were associated with lower access to first KT. KT candidates between 15 and 19 years had lower access to first and second KT (aHR: 0.69; 95%CI: 0.66-0.73, and aHR: 0.70; 95%CI: 0.61-0.81) compared to 10-14 year-olds. Compared to CAKUT, glomerulonephritis patients had lower access to KT (aHR: 0.75; 95%CI: 0.71-0.80 for first, aHR: 0.89; 95%CI: 0.81-0.98 for second, and aHR: 0.80; 95%CI: 0.66-0.97 for third KT). Similarly, patients with primary renal diseases with high risk of recurrence, had lower chances of receiving a first and second KT (aHR: 0.80; 95%CI: 0.76-0.85 for first, aHR: 0.86; 95%CI: 0.78-0.95 for second KT). Access to re-Transplantation was also higher with previous pre-emptive KT and previous graft survival exceeding 5 years. Conclusion Our study highlights KT access disparities particularly for females, the youngest recipients, high-risk age (15-19 years), and diseases with recurrence risk. Notably, pre-emptive transplants and enduring previous grafts offer advantages regarding re-Transplantation.</p>}},
author = {{Preka, Evgenia and Bonthuis, Marjolein and Marks, Stephen D. and Kramer, Anneke and De Vries, Aiko P.J. and Sørensen, Søren S. and Bakkaloǧlu, Sevcan A. and Bistrup, Claus and Jahnukainen, Timo and Rodriguez Arévalo, Olga L. and Buchwinkler, Lukas and Segelmark, Mårten and Sanchez, J. Emilio and Arnol, Miha and Ordóñez-Álvarez, Flor A. and De La Cerda-Ojeda, Francisco and Plumb, Lucy A. and Methven, Shona and Palsson, Runolfur and Lundgren, Torbjörn and Ríos, Héctor and Ortiz, Alberto and Stel, Vianda S. and Harambat, Jerome and Jager, Kitty J.}},
issn = {{0931-0509}},
keywords = {{epidemiology; high-risk age window; kidney transplantation; paediatric; re-Transplantation}},
language = {{eng}},
month = {{08}},
number = {{8}},
pages = {{1580--1589}},
publisher = {{Oxford University Press}},
series = {{Nephrology Dialysis Transplantation}},
title = {{Access to kidney transplantation and re-Transplantation from childhood to adulthood : Long-Term data from the ERA Registry}},
url = {{http://dx.doi.org/10.1093/ndt/gfaf025}},
doi = {{10.1093/ndt/gfaf025}},
volume = {{40}},
year = {{2025}},
}