Pediatric Kidney Transplantation in Europe, a Clinical Snapshot Pilot

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2024 Nov 8

PMID 39513158

Authors

Loes Oomen

Charlotte M H H T Bootsma-Robroeks

Antonia H M Bouts

Mar Carbonell Pradas

Romy Gander

Katrin Kienzl-Wagner

Paul Konig

Pedro Lopez Pereira

Olivier Dunand

Sara M F S Mosca

Michal Pac

Ludmila Podracka

Agnieszka A Prytula

Maria Sangermano

Renata Vitkevic

Jakub Zieg

Loes F M van der Zanden

Wout F J Feitz

Liesbeth L de Wall

Affiliations

Soon will be listed here.

Abstract

Background: Pediatric kidney transplantations are rarely performed, and there is limited knowledge about the diversity in current clinical practices across Europe. This study aims to explore the utility of clinical snapshot studies in identifying these disparities, establishing a foundation for future snapshot studies and standardization efforts.

Methods: A pilot clinical snapshot study was conducted, with invitations extended to all 109 pediatric kidney transplant centres in Europe. Each participating centre provided pre-, peri-, and postoperative data concerning their most recent thirty transplantations. The primary outcomes encompassed the evaluation of disparities in donor-recipient selection, surgical techniques, post-operative drainage procedures, and immunosuppressive therapy protocols. Secondary outcomes involved the analysis of rejection rates, incidence of infections, and graft survival.

Results: The study involved 439 patients from fifteen centres (14%) in twelve countries, with varying transplant volumes (range 1-29 transplantations per year) and follow-up periods. Significant differences were found among centres in terms of donor types, cold and warm ischemia time, pre-emptive transplant rates, and kidney transplant drainage methods. The rate of living donors varied between 3% and 90% and the median duration of cold ischemia ranged was 770 min after deceased donation and 147 min after living donation. Basiliximab was the dominant induction therapy, yet steroid withdrawal varied widely. Infection, rejection, and graft survival rates also varied significantly between centres.

Conclusion: This study revealed substantial variation in clinical practices among European centres performing pediatric kidney transplantations. These findings could serve as a stimulus for international dialogue and collaboration.

Citing Articles

International validation of a pre-transplant risk assessment tool for graft survival in pediatric kidney transplant recipients.

Oomen L, de Wall L, Tonshoff B, Krupka K, Harambat J, Hogan J Clin Kidney J. 2025; 18(3):sfaf031.

PMID: 40052169 PMC: 11883223. DOI: 10.1093/ckj/sfaf031.

References

Golob Jancic S, Mocnik M, Marcun Varda N . Glomerular Filtration Rate Assessment in Children. Children (Basel). 2022; 9(12). PMC: 9776896. DOI: 10.3390/children9121995. View

Faba O, Boissier R, Budde K, Figueiredo A, Taylor C, Hevia V . European Association of Urology Guidelines on Renal Transplantation: Update 2018. Eur Urol Focus. 2018; 4(2):208-215. DOI: 10.1016/j.euf.2018.07.014. View

Kim J, Lorenzo A, Farhat W, Chua M, Ming J, Dos Santos J . A comparison of post-transplant renal function in pre-emptive and post-dialysis pediatric kidney transplant recipients. Pediatr Transplant. 2019; 23(3):e13377. DOI: 10.1111/petr.13377. View

Chinnakotla S, Verghese P, Chavers B, Rheault M, Kirchner V, Dunn T . Outcomes and Risk Factors for Graft Loss: Lessons Learned from 1,056 Pediatric Kidney Transplants at the University of Minnesota. J Am Coll Surg. 2017; 224(4):473-486. DOI: 10.1016/j.jamcollsurg.2016.12.027. View

Tennankore K, Kim S, Alwayn I, Kiberd B . Prolonged warm ischemia time is associated with graft failure and mortality after kidney transplantation. Kidney Int. 2016; 89(3):648-58. DOI: 10.1016/j.kint.2015.09.002. View

Oomen L, de Wall L, Krupka K, Tonshoff B, Wlodkowski T, Van Der Zanden L . The strengths and complexities of European registries concerning paediatric kidney transplantation health care. Front Pediatr. 2023; 11:1121282. PMC: 10073744. DOI: 10.3389/fped.2023.1121282. View

Bonthuis M, Vidal E, Bjerre A, Aydog O, Baiko S, Garneata L . Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry. Pediatr Nephrol. 2021; 36(8):2337-2348. PMC: 8260419. DOI: 10.1007/s00467-021-04928-w. View

Wijnen M, Hulscher J . Centralization of pediatric surgical care in the Netherlands: Lessons learned. J Pediatr Surg. 2021; 57(2):178-181. DOI: 10.1016/j.jpedsurg.2021.10.023. View

Contento M, Vercillo R, Malaga-Dieguez L, Pehrson L, Wang Y, Liu M . Center Volume and Kidney Transplant Outcomes in Pediatric Patients. Kidney Med. 2020; 2(3):297-306. PMC: 7380383. DOI: 10.1016/j.xkme.2020.01.008. View

10.

Woodle E, Gill J, Clark S, Stewart D, Alloway R, First R . Early Corticosteroid Cessation vs Long-term Corticosteroid Therapy in Kidney Transplant Recipients: Long-term Outcomes of a Randomized Clinical Trial. JAMA Surg. 2021; 156(4):307-314. PMC: 7859872. DOI: 10.1001/jamasurg.2020.6929. View

11.

Bassanese G, Wlodkowski T, Servais A, Heidet L, Roccatello D, Emma F . The European Rare Kidney Disease Registry (ERKReg): objectives, design and initial results. Orphanet J Rare Dis. 2021; 16(1):251. PMC: 8173879. DOI: 10.1186/s13023-021-01872-8. View

12.

Tonshoff B, Tedesco-Silva H, Ettenger R, Christian M, Bjerre A, Dello Strologo L . Three-year outcomes from the CRADLE study in de novo pediatric kidney transplant recipients receiving everolimus with reduced tacrolimus and early steroid withdrawal. Am J Transplant. 2020; 21(1):123-137. DOI: 10.1111/ajt.16005. View

13.

Oomen L, Bootsma-Robroeks C, Cornelissen E, de Wall L, Feitz W . Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades. Front Pediatr. 2022; 10:856630. PMC: 9024248. DOI: 10.3389/fped.2022.856630. View

14.

Chandar J, Chen L, Defreitas M, Ciancio G, Burke 3rd G . Donor considerations in pediatric kidney transplantation. Pediatr Nephrol. 2020; 36(2):245-257. DOI: 10.1007/s00467-019-04362-z. View

15.

Grenda R, Watson A, Trompeter R, Tonshoff B, Jaray J, Fitzpatrick M . A randomized trial to assess the impact of early steroid withdrawal on growth in pediatric renal transplantation: the TWIST study. Am J Transplant. 2010; 10(4):828-836. DOI: 10.1111/j.1600-6143.2010.03047.x. View

16.

Friedersdorff F, Weinberger S, Biernath N, Plage H, Cash H, El-Bandar N . The Ureter in the Kidney Transplant Setting: Ureteroneocystostomy Surgical Options, Double-J Stent Considerations and Management of Related Complications. Curr Urol Rep. 2020; 21(1):3. DOI: 10.1007/s11934-020-0956-7. View

17.

Debout A, Foucher Y, Trebern-Launay K, Legendre C, Kreis H, Mourad G . Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation. Kidney Int. 2014; 87(2):343-9. DOI: 10.1038/ki.2014.304. View

18.

Harambat J, van Stralen K, Schaefer F, Grenda R, Jankauskiene A, Kostic M . Disparities in policies, practices and rates of pediatric kidney transplantation in Europe. Am J Transplant. 2013; 13(8):2066-74. DOI: 10.1111/ajt.12288. View

19.

Voet M, Lemson J, Cornelissen M, Malagon I . Anesthesia and intensive care unit care in pediatric kidney transplantation: An international survey. Paediatr Anaesth. 2023; 34(3):235-242. DOI: 10.1111/pan.14810. View

20.

Ljungman P, Boeckh M, Hirsch H, Josephson F, Lundgren J, Nichols G . Definitions of Cytomegalovirus Infection and Disease in Transplant Patients for Use in Clinical Trials. Clin Infect Dis. 2016; 64(1):87-91. DOI: 10.1093/cid/ciw668. View