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Long-term outcomes during 37 years of pediatric kidney transplantation: a cohort study comparing ethnic groups

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Abstract

Background

This study aimed to evaluate short- and long-term outcomes of kidney transplantation over 37 years in a national referral center and compare outcomes between Israeli Jewish and Arab children.

Methods

Data on 599 pediatric transplantations performed in 545 children during 1981–2017, including demographic parameters, kidney failure disease profile, and pre-transplant dialysis duration, were retrieved from our computerized database and patient files. Patient and graft survival were estimated using the Kaplan-Meier method.

Results

Twenty-year patient survival was 91.4% for live donor (LD) and 80.2% for deceased donor (DD) kidney recipients. Respective 10-year and 20-year graft survival rates for first kidney-only transplants were 75.2% and 47.0% for LD and 60.7% and 38.4% for DD grafts. Long-term graft survival improved significantly (p < 0.001) over the study period for recipients of both LD and DD allografts and reached 7-year graft survival of 92.0% and 71.3%, respectively. The proportion of DD transplantations was higher in the Arab subpopulation: 73.8% vs. 48.4% (p < 0.001). Graft survival was not associated with age at transplantation and did not differ between the Arab (N = 202) and Jewish children (N = 343). Median (IQR) waiting time on dialysis did not differ significantly between the Arab and Jewish children: 18 (10–30) and 15 (9–30) months, respectively (p Mann-Whitney = 0.312).

Conclusions

Good and progressively improving long-term results were obtained in pediatric kidney transplantation at our national referral center, apparently due to expertise gained over time and advances in immunosuppression. Equal access to DD kidney transplant and similar graft survival were found between ethnic groups.

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Data availability

The authors will provide access to data upon reasonable request.

References

  1. Chua A, Cramer C, Moudgil A, Martz K, Smith J, Blydt-Hansen T, Neu A, Dharnidharka VR (2019) NAPRTCS investigators. Kidney transplant practice patterns and outcome benchmarks over 30 years: the 2018 report of the NAPRTCS. Pediatr Transplant 23:e13597

    Article  Google Scholar 

  2. Mumford L, Maxwell H, Ahmad N, Marks SD, Tizard J (2019) The impact of changing practice on improved outcomes of paediatric renal transplantation in the United Kingdom: a 25 years review. Transpl Int 32:751–761

    Article  Google Scholar 

  3. Francis A, Johnson DW, Melk A, Foster BJ, Blazek K, Craig JC, Wong G (2020) Survival after kidney transplantation during childhood and adolescence. Clin J Am Soc Nephrol 15:392–400

    Article  Google Scholar 

  4. Aoki Y, Hamasaki Y, Satoh H, Matsui Z, Muramatsu M, Hamada R, Ishikura K, Hataya H, Honda M, Sakai K, Shishido S (2020) Long-term outcomes of pediatric kidney transplantation: a single-center experience over the past 34 years in Japan. Int J Urol 27:172–178

    Article  CAS  Google Scholar 

  5. Van Arendonk K, Boyarsky BJ, Orandi BJ, James NT, Smith JM, Colombani PM, Segev DL (2014) National trends over 25 years of pediatric kidney transplant outcomes. Pediatrics 133:594–601

    Article  Google Scholar 

  6. Branco F, Almeida F, Cavadas V, Ribeiro S, Osório L, Rocha A, Ramos M, Martins L, Dias L, Castro-Henriques A, Mota C, Reis A, Fraga A (2013) Pediatric kidney transplantation: a single center experience with 134 procedures. Transplant Proc 45:1057–1059

    Article  CAS  Google Scholar 

  7. Harambat J, Ranchin B, Bertholet-Thomas A, Mestrallet G, Bacchetta J, Badet L, Basmaison O, Bouvier R, Demède D, Dubourg L, Floret D, Martin X, Cochat P (2013) Long-term critical issues in pediatric renal transplant recipients: a single-center experience. Transpl Int 26:154–161

    Article  CAS  Google Scholar 

  8. Patzer RE, Sayed BA, McClellan WM, Kutner N, Amaral S (2013) Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States. Am J Transplant 13:1769–1781

    Article  CAS  Google Scholar 

  9. Patzer RE, Mohan S, Kutner N, McClellan WM, Amaral S (2015) Racial and ethnic disparities in pediatric renal allograft survival in the United States. Kidney Int 87:584–592

    Article  Google Scholar 

  10. Ku E, McCulloch CE, Grimes BA, Johansen KL (2017) Racial and ethnic disparities in survival of children with ESRD. J Am Soc Nephrol 28:1584–1591

    Article  Google Scholar 

  11. Laster M, Sohoo M, Hall C, Streja E, Rhee C, Ravel V, Reddy U, Norris K, Salusky I, Kalantar-Zadeh K (2017) Racial-ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients. Pediatr Nephrol 32:685–695

    Article  Google Scholar 

  12. Tjaden LA, Noordzij M, van Stralen KJ, Kuehni CE, Raes A, Cornelissen EAM, O’Brien C, Papachristou F, Schaefer F, Groothoff JW, Jager KJ (2016) Racial disparities in access to and outcomes of kidney transplantation in children, adolescents and young adults: results from the ESPN/ERA- EDTA. Am J Kidney Dis 67:293–301

    Article  Google Scholar 

  13. Dittmer I, Wilkinson M (2014) Racial disparities in pediatric kidney transplantation in New Zealand. Pediatr Transplant 18:689–697

    Article  Google Scholar 

  14. Israel Central Bureau of Statistics. Monthly Bulletin of Statistics – April 2020. https://www.cbs.gov.il/he/publications/doclib/2020/yarhon0420/b1.pdf. Accessed 16 Jan 2021

  15. Israel Center for Disease Control. Ministry of Health. ESRD Registry. https://www.health.gov.il/English/MinistryUnits/ICDC/disease_Registries/Pages/Alternative_kidney_treatment.aspx. Accessed 16 Jan 2021

  16. Jamieson NV (2005) A 20-year experience of combined liver/kidney transplantation for primary hyperoxaluria (PH1): the European PH1 transplant registry experience 1984-2004. Am J Nephrol 25:282–289

    Article  Google Scholar 

  17. Collaborative Transplant Study. https://www.ctstransplant.org/public/participants/regionMes.shtml. Accessed 16 Jan 2021

  18. Smith JM, Martz K, Blydt-Hansen TM (2013) Pediatric kidney transplant practice patterns and outcome benchmarks, 1987-2010: a report of the North American Pediatric Renal Trials and Collaborative Studies. Pediatr Transplant 17:149–157

    Article  Google Scholar 

  19. Rees L, Shroff R, Hutchinson C, Fernando ON, Trompeter RS (2007) Long-term outcome of paediatric renal transplantation: follow-up of 300 children from 1973 to 2000. Nephron Clin Pract 105:c68–c76

    Article  Google Scholar 

  20. Groothoff JW, Cransberg K, Offringa M, van de Kar NJ, Lilien MR, Davin JC, Heymans HAS, Dutch cohort study (2004) Long-term follow-up of renal transplantation in children: a Dutch Cohort Study. Transplantation 78:453–460

    Article  Google Scholar 

  21. Tangeraas T, Bjerre A, Lien B, Kyte A, Monn E, Cvancarova M, Leivestad T, Reisaeter AV (2008) Long-term outcome of pediatric renal transplantation: the Norwegian experience in three eras 1970–2006. Pediatr Transplant 12:762–768

    Article  Google Scholar 

  22. Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Castro S (2020) OPTN/SRTR 2018 Annual Data Report: Kidney. Am J Transplant 20(Suppl s1):20–130

    Article  Google Scholar 

  23. Holmberg C, Jalanko H (2016) Long term effects of pediatric kidney transplantation. Nat Rev Nephrol 12:301–311

    Article  CAS  Google Scholar 

  24. Jaber L, Halpern GJ (2006) Consanguinity among the Arab and Jewish populations in Israel. Pediatr Endocrinol Rev Suppl l3:437–446

    Google Scholar 

  25. Na'amnih W, Romano-Zelekha O, Kabaha A, Rubin LP, Bilenko N, Jaber L, Honovich M, Shohat T (2015) Continuous decrease of consanguineous marriages among Arabs in Israel. Am J Hum Biol 27:94–98

    Article  Google Scholar 

  26. Andreoni KA, Forbes R, Andreoni RM (2013) Age-related kidney transplant outcomes: health disparities amplified in adolescence. JAMA Intern Med 173:1524–1532

    Article  Google Scholar 

  27. Cohen J, Ashkenazi T, Katvanc E, Singera P (2012) Brain death determination in Israel: the first two years experience following changes to the brain death law—opportunities and challenges. Am J Transplant 12:2514–2518

    Article  CAS  Google Scholar 

  28. Lavee J, Ashkenazi T, Stoler A, Cohen J, Beyar R (2013) Preliminary marked increase in the national organ donation rate in Israel following implementation of a new organ transplantation law. Am J Transplant 13:780–785

    Article  CAS  Google Scholar 

  29. Drukker A, Feinstein S, Rinat C, Rotem-Braun A, Frishberg Y (2003) Cadaver-Donor renal transplantation of children in Israel (1990-2001): racial disparities in health care delivery? Pediatrics 112:341–344

    Article  Google Scholar 

  30. Darnidharka VR, Selfert ME (2015) Kidney transplant results in children: progress made, but blacks lag behind. Kidney Int 87:492–494

    Article  Google Scholar 

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Authors and Affiliations

  1. Institute of Nephrology, Schneider Children’s Medical Center of Israel, 49202, Petah Tikva, Israel

    Miriam Davidovits, Lewis Reisman, Irit Krause, Amit Dagan, Neomi Zanhendler & Osnat Hocherman

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Miriam Davidovits, Roxana Cleper, Irit Krause, Amit Dagan, Gabriel Chodick & Eytan Mor

  3. Pediatric Nephrology Unit, Dana-Dweq Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Roxana Cleper

  4. Department of Transplantation, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Nathan Bar-Nathan, Maya Mor, Sigal Aisner & Eytan Mor

Authors
  1. Miriam Davidovits
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  2. Lewis Reisman
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  3. Roxana Cleper
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  8. Gabriel Chodick
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  10. Maya Mor
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Correspondence to Miriam Davidovits.

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All authors approved the final draft of the manuscript and agree to be accountable for all aspects of the work.

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The authors declare that they have no conflict of interest.

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The study was approved by the Institutional Research Ethics Board of Rabin Medical Center and Schneider Children’s Medical Center of Israel.

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Davidovits, M., Reisman, L., Cleper, R. et al. Long-term outcomes during 37 years of pediatric kidney transplantation: a cohort study comparing ethnic groups. Pediatr Nephrol 36, 1881–1888 (2021). https://doi.org/10.1007/s00467-020-04908-6

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  • DOI: https://doi.org/10.1007/s00467-020-04908-6

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