Access to kidney transplantation and re-transplantation from childhood to adulthood: long-term data from the ERA Registry

Evgenia Preka; Marjolein Bonthuis; Stephen d Marks; Anneke Kramer; Aiko p j De vries; Søren s Sørensen; Sevcan a Bakkaloğlu; Claus Bistrup; Timo Jahnukainen; Olga l Rodriguez arévalo; Lukas Buchwinkler; Mårten Segelmark; J emilio Sanchez; Miha Arnol; Flor a Ordóñez-Álvarez; Francisco De la cerda-Ojeda; Lucy a Plumb; Shona Methven; Runolfur Palsson; Torbjörn Lundgren; Héctor Ríos; Alberto Ortiz; Vianda s Stel; Jerome Harambat; Kitty j Jager

doi:10.1093/ndt/gfaf025

Access to kidney transplantation and re-transplantation from childhood to adulthood: long-term data from the ERA Registry

Evgenia Preka, Marjolein Bonthuis, Stephen d Marks, Anneke Kramer, Aiko p j De vries, Søren s Sørensen, Sevcan a Bakkaloğlu, Claus Bistrup, Timo Jahnukainen, Olga l Rodriguez arévalo, Lukas Buchwinkler, Mårten Segelmark, J emilio Sanchez, Miha Arnol, Flor a Ordóñez-Álvarez, Francisco De la cerda-Ojeda, Lucy a Plumb, Shona Methven, Runolfur Palsson, Torbjörn LundgrenHéctor Ríos, Alberto Ortiz, Vianda s Stel, Jerome Harambat, Kitty j Jager

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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 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.

Original language	English
Article number	gfaf025
Journal	Nephrology Dialysis Transplantation
Early online date	12 Feb 2025
DOIs	https://doi.org/10.1093/ndt/gfaf025
Publication status	E-pub ahead of print - 12 Feb 2025

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Preka, E., Bonthuis, M., Marks, S. D., Kramer, A., De vries, A. P. J., Sørensen, S. S., Bakkaloğlu, S. A., Bistrup, C., Jahnukainen, T., Rodriguez arévalo, O. L., Buchwinkler, L., Segelmark, M., Sanchez, J. E., Arnol, M., Ordóñez-Álvarez, F. A., De la cerda-Ojeda, F., Plumb, L. A., Methven, S., Palsson, R., ... Jager, K. J. (2025). Access to kidney transplantation and re-transplantation from childhood to adulthood: long-term data from the ERA Registry. Nephrology Dialysis Transplantation, Article gfaf025. Advance online publication. https://doi.org/10.1093/ndt/gfaf025

@article{2722bd42f7284f0fb1e816064c96ae43,

title = "Access to kidney transplantation and re-transplantation from childhood to adulthood: long-term data from the ERA Registry",

abstract = "Background and hypothesisKnowledge regarding access to first kidney transplantation (KT) and subsequent KT in patients commencing kidney replacement therapy (KRT) in childhood is limited.MethodsUsing 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.ResultsTotals 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.ConclusionOur 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.",

author = "Evgenia Preka and Marjolein Bonthuis and Marks, {Stephen d} and Anneke Kramer and {De vries}, {Aiko p j} and S{\o}rensen, {S{\o}ren s} and Bakkaloğlu, {Sevcan a} and Claus Bistrup and Timo Jahnukainen and {Rodriguez ar{\'e}valo}, {Olga l} and Lukas Buchwinkler and M{\aa}rten Segelmark and Sanchez, {J emilio} and Miha Arnol and Ord{\'o}{\~n}ez-{\'A}lvarez, {Flor a} and {De la cerda-Ojeda}, Francisco and Plumb, {Lucy a} and Shona Methven and Runolfur Palsson and Torbj{\"o}rn Lundgren and H{\'e}ctor R{\'i}os and Alberto Ortiz and Stel, {Vianda s} and Jerome Harambat and Jager, {Kitty j}",

year = "2025",

month = feb,

day = "12",

doi = "10.1093/ndt/gfaf025",

language = "English",

journal = "Nephrology Dialysis Transplantation",

issn = "0931-0509",

publisher = "Oxford University Press",

}

Preka, E, Bonthuis, M, Marks, SD, Kramer, A, De vries, APJ, Sørensen, SS, Bakkaloğlu, SA, Bistrup, C, Jahnukainen, T, Rodriguez arévalo, OL, Buchwinkler, L, Segelmark, M, Sanchez, JE, Arnol, M, Ordóñez-Álvarez, FA, De la cerda-Ojeda, F, Plumb, LA, Methven, S, Palsson, R, Lundgren, T, Ríos, H, Ortiz, A, Stel, VS, Harambat, J & Jager, KJ 2025, 'Access to kidney transplantation and re-transplantation from childhood to adulthood: long-term data from the ERA Registry', Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfaf025

TY - JOUR

T1 - Access to kidney transplantation and re-transplantation from childhood to adulthood

T2 - long-term data from the ERA Registry

AU - Preka, Evgenia

AU - Bonthuis, Marjolein

AU - Marks, Stephen d

AU - Kramer, Anneke

AU - De vries, Aiko p j

AU - Sørensen, Søren s

AU - Bakkaloğlu, Sevcan a

AU - Bistrup, Claus

AU - Jahnukainen, Timo

AU - Rodriguez arévalo, Olga l

AU - Buchwinkler, Lukas

AU - Segelmark, Mårten

AU - Sanchez, J emilio

AU - Arnol, Miha

AU - Ordóñez-Álvarez, Flor a

AU - De la cerda-Ojeda, Francisco

AU - Plumb, Lucy a

AU - Methven, Shona

AU - Palsson, Runolfur

AU - Lundgren, Torbjörn

AU - Ríos, Héctor

AU - Ortiz, Alberto

AU - Stel, Vianda s

AU - Harambat, Jerome

AU - Jager, Kitty j

PY - 2025/2/12

Y1 - 2025/2/12

N2 - Background and hypothesisKnowledge regarding access to first kidney transplantation (KT) and subsequent KT in patients commencing kidney replacement therapy (KRT) in childhood is limited.MethodsUsing 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.ResultsTotals 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.ConclusionOur 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.

AB - Background and hypothesisKnowledge regarding access to first kidney transplantation (KT) and subsequent KT in patients commencing kidney replacement therapy (KRT) in childhood is limited.MethodsUsing 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.ResultsTotals 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.ConclusionOur 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.

U2 - 10.1093/ndt/gfaf025

DO - 10.1093/ndt/gfaf025

M3 - Article (Academic Journal)

C2 - 39938931

SN - 0931-0509

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

M1 - gfaf025

ER -