Nicholas G Larkins1,2,3, Germaine Wong4,5,6, Stephen I Alexander6,7, Stephen McDonald8,9, Chanel Prestidge10, Anna Francis11, Amelia K Le Page12, Wai H Lim13,14. 1. Department of Nephrology and Hypertension, Perth Children's Hospital, 15 University Ave, Nedlands, WA, 6009, Australia. nicholas.larkins@uwa.edu.au. 2. School of Medicine, University of Western Australia, Perth, WA, Australia. nicholas.larkins@uwa.edu.au. 3. Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia. nicholas.larkins@uwa.edu.au. 4. Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia. 5. Department of Nephrology, Westmead Hospital, Sydney, NSW, Australia. 6. School of Public Health, University of Sydney, Sydney, NSW, Australia. 7. Department of Nephrology, Westmead Children's Hospital, Westmead, NSW, Australia. 8. Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Royal Adelaide Hospital, Adelaide, SA, Australia. 9. Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia. 10. Starship Child Health, Auckland, New Zealand. 11. Child and Adolescent Renal Service, Queensland Children's Hospital, South Brisbane, QLD, Australia. 12. Department of Nephrology, Monash Children's Hospital, Clayton, VIC, Australia. 13. School of Medicine, University of Western Australia, Perth, WA, Australia. 14. Department of Nephrology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Abstract
BACKGROUND: Young children starting kidney replacement therapy (KRT) suffer high disease burden with unique impacts on growth and development, timing of transplantation and long-term survival. Contemporary long-term outcome data and how these relate to patient characteristics are necessary for shared decision-making with families, to identify modifiable risk factors and inform future research. METHODS: We examined outcomes of all children ≤ 5 years enrolled in the Australia and New Zealand Dialysis and Transplant Registry, commencing KRT 1980-2017. Primary outcomes were patient and graft survival. Final height attained was also examined. We used generalized additive modelling to investigate the relationship between age and graft loss over time post-transplant. RESULTS: In total, 388 children were included, of whom 322 (83%) received a kidney transplant. Cumulative 1-, 5- and 10-year patient survival probabilities were 93%, 86% and 83%, respectively. Death censored graft survival at 1, 5 and 10 years was 93%, 87% and 77%, respectively. Most children were at least 10 kg at transplantation (n = 302; 96%). A non-linear relationship between age at transplantation and graft loss was observed, dependent on time post-transplant, with increased risk of graft loss among youngest recipients both initially following transplantation and subsequently during adolescence. Graft and patient survival have improved in recent era. CONCLUSIONS: Young children commencing KRT have good long-term survival and graft outcomes. Early graft loss is no reason to postpone transplantation beyond 10 kg, and among even the youngest recipients, late graft loss risk in adolescence remains one of the greatest barriers to improving long-term outcomes.
BACKGROUND: Young children starting kidney replacement therapy (KRT) suffer high disease burden with unique impacts on growth and development, timing of transplantation and long-term survival. Contemporary long-term outcome data and how these relate to patient characteristics are necessary for shared decision-making with families, to identify modifiable risk factors and inform future research. METHODS: We examined outcomes of all children ≤ 5 years enrolled in the Australia and New Zealand Dialysis and Transplant Registry, commencing KRT 1980-2017. Primary outcomes were patient and graft survival. Final height attained was also examined. We used generalized additive modelling to investigate the relationship between age and graft loss over time post-transplant. RESULTS: In total, 388 children were included, of whom 322 (83%) received a kidney transplant. Cumulative 1-, 5- and 10-year patient survival probabilities were 93%, 86% and 83%, respectively. Death censored graft survival at 1, 5 and 10 years was 93%, 87% and 77%, respectively. Most children were at least 10 kg at transplantation (n = 302; 96%). A non-linear relationship between age at transplantation and graft loss was observed, dependent on time post-transplant, with increased risk of graft loss among youngest recipients both initially following transplantation and subsequently during adolescence. Graft and patient survival have improved in recent era. CONCLUSIONS: Young children commencing KRT have good long-term survival and graft outcomes. Early graft loss is no reason to postpone transplantation beyond 10 kg, and among even the youngest recipients, late graft loss risk in adolescence remains one of the greatest barriers to improving long-term outcomes.