Julien Hogan1,2, Justine Bacchetta3, Marina Charbit4, Gwenaelle Roussey5, Robert Novo6, Michel Tsimaratos7, Joelle Terzic8, Tim Ulinski9, Arnaud Garnier10, Elodie Merieau11, Jérôme Harambat12, Isabelle Vrillon13, Olivier Dunand14, Denis Morin15, Etienne Berard16, Francois Nobili17, Cécile Couchoud2, Marie-Alice Macher1,2. 1. Pediatric Nephrology Department, Robert Debré University Hospital, APHP, Paris, France. 2. Agence de la Biomédecine, La Plaine Saint-Denis, France. 3. Pediatric Nephrology Department, HFME, Lyon University Hospital, Bron, France. 4. Pediatric Nephrology Department, Necker University Hospital, APHP, Paris, France. 5. Pediatric Nephrology Department, Nantes University Hospital, Nantes, France. 6. Pediatric Nephrology Department, Jeanne de Flandre University Hospital, Lille, France. 7. Pediatric Nephrology Department, La Timone University Hospital, Marseille, France. 8. Pediatric Nephrology Department, Hautepierre University Hospital, Strasbourg, France. 9. Pediatric Nephrology Department, Armand Trousseau University Hospital, APHP, Paris, France. 10. Pediatric Nephrology Department, Children University Hospital, Toulouse, France. 11. Pediatric Nephrology Department, Tours University Hospital, Tours, France. 12. Pediatric Nephrology Department, Pellegrin University Hospital, Bordeaux, France. 13. Pediatric Nephrology Department, Nancy University Hospital, Nancy, France. 14. Pediatric Nephrology Department, Felix Guyon University Hospital, Saint-Denis de la Réunion, France. 15. Pediatric Nephrology Department, Montpellier University Hospital, Montpellier, France. 16. Pediatric Nephrology Department, Lenval University Hospital, Nice, France. 17. Pediatric Nephrology Department, Saint Jacques University Hospital, Besançon, France.
Abstract
Background: Despite major technical improvements in the care of children requiring renal replacement therapy (RRT) before 2 years of age, the management of those patients remains challenging and transplantation is generally delayed until the child weighs 10 kg or is 2 years old. In this national cohort study, we studied patient and graft survival in children starting RRT before 2 years of age to help clinicians and parents when deciding on RRT initiation and transplantation management. Methods: All children starting RRT before 24 months of age between 1992 and 2012 in France were included through the national Renal Epidemiology and Information Network (REIN) registry. The primary endpoints were patient survival on dialysis and 10-year graft survival. Results: A total of 224 patients were included {62% boys, median age 10.5 months [interquartile range (IQR) 5.8-15.6]}. The 10-year survival rate was 84% (IQR 77-89). Suffering from extrarenal comorbidities was the only factor significantly associated with both an increased risk of death on dialysis [hazard ratio 5.9 (95% confidence interval 1.8-19.3)] and a decreased probability of being transplanted. During follow-up, 174 renal transplantations were performed in 171 patients [median age at first transplantation 30.2 (IQR 21.8-40.7) months]. The 10-year graft survival was 74% (IQR 67-81). Factors associated with graft loss in multivariate analysis were the time spent on dialysis before transplantation, donor/recipient height ratio with an increased risk for both small and tall donors and presenting two human leucocyte antigen-antigen D-related mismatches. Conclusions: This study confirms the good outcome of children starting RRT before 2 years of age. The main question remains when and how to transplant those children. Our study provides data on the optimal morphological and immunological matching in order to help clinicians in their decisions.
Background: Despite major technical improvements in the care of children requiring renal replacement therapy (RRT) before 2 years of age, the management of those patients remains challenging and transplantation is generally delayed until the child weighs 10 kg or is 2 years old. In this national cohort study, we studied patient and graft survival in children starting RRT before 2 years of age to help clinicians and parents when deciding on RRT initiation and transplantation management. Methods: All children starting RRT before 24 months of age between 1992 and 2012 in France were included through the national Renal Epidemiology and Information Network (REIN) registry. The primary endpoints were patient survival on dialysis and 10-year graft survival. Results: A total of 224 patients were included {62% boys, median age 10.5 months [interquartile range (IQR) 5.8-15.6]}. The 10-year survival rate was 84% (IQR 77-89). Suffering from extrarenal comorbidities was the only factor significantly associated with both an increased risk of death on dialysis [hazard ratio 5.9 (95% confidence interval 1.8-19.3)] and a decreased probability of being transplanted. During follow-up, 174 renal transplantations were performed in 171 patients [median age at first transplantation 30.2 (IQR 21.8-40.7) months]. The 10-year graft survival was 74% (IQR 67-81). Factors associated with graft loss in multivariate analysis were the time spent on dialysis before transplantation, donor/recipient height ratio with an increased risk for both small and tall donors and presenting two human leucocyte antigen-antigen D-related mismatches. Conclusions: This study confirms the good outcome of children starting RRT before 2 years of age. The main question remains when and how to transplant those children. Our study provides data on the optimal morphological and immunological matching in order to help clinicians in their decisions.