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Survival and transplant outcomes among young children requiring kidney replacement therapy

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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.

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Acknowledgements

The data reported here have been supplied by the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).

Funding

WHL and NGL are supported by a Clinical Research Fellowships from the Raine Foundation (University of Western Australia and Health Department of Western Australia), and (WHL) Jacquot Research Foundation (Royal Australasian College of Physicians). GW is supported by a National Health and Medical Research Council Career Development Fellowship.

Author information

Authors and Affiliations

  1. Department of Nephrology and Hypertension, Perth Children’s Hospital, 15 University Ave, Nedlands, WA, 6009, Australia

    Nicholas G. Larkins

  2. School of Medicine, University of Western Australia, Perth, WA, Australia

    Nicholas G. Larkins & Wai H. Lim

  3. Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia

    Nicholas G. Larkins & Germaine Wong

  4. Department of Nephrology, Westmead Hospital, Sydney, NSW, Australia

    Germaine Wong

  5. School of Public Health, University of Sydney, Sydney, NSW, Australia

    Germaine Wong & Stephen I. Alexander

  6. Department of Nephrology, Westmead Children’s Hospital, Westmead, NSW, Australia

    Stephen I. Alexander

  7. Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Royal Adelaide Hospital, Adelaide, SA, Australia

    Stephen McDonald

  8. Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia

    Stephen McDonald

  9. Starship Child Health, Auckland, New Zealand

    Chanel Prestidge

  10. Child and Adolescent Renal Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia

    Anna Francis

  11. Department of Nephrology, Monash Children’s Hospital, Clayton, VIC, Australia

    Amelia K. Le Page

  12. Department of Nephrology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Wai H. Lim

Authors
  1. Nicholas G. Larkins
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  2. Germaine Wong
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  3. Stephen I. Alexander
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  4. Stephen McDonald
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  5. Chanel Prestidge
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  6. Anna Francis
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  7. Amelia K. Le Page
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  8. Wai H. Lim
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Contributions

All authors contributed to the study design, data interpretation and manuscript preparation. NGL performed the data analysis. All authors approved the final version for publication and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Nicholas G. Larkins.

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Conflict of interest

The authors declare that they have no conflict of interest.

Disclaimer

The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the Australia and New Zealand Dialysis and Transplant Registry.

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Larkins, N.G., Wong, G., Alexander, S.I. et al. Survival and transplant outcomes among young children requiring kidney replacement therapy. Pediatr Nephrol 36, 2443–2452 (2021). https://doi.org/10.1007/s00467-021-04945-9

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  • DOI: https://doi.org/10.1007/s00467-021-04945-9

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