Policy variation in donor and recipient status in 11 pediatric renal transplantation centers
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Evidence-based guidelines for pediatric renal transplantation (Tx) are lacking. This may lead to unwanted treatment variations. We aimed to quantify the variation in treatment policies and its consequences in daily practice in 11 centers that provide renal Tx for children in three European countries.
We surveyed Tx policies in all ten centers in the Netherlands and Belgium and one center in Germany. We compared Tx policies with the therapies actually provided and with recommendations from available published guidelines and existing literature. Information on treatment policies was obtained by a questionnaire; information on care actually provided was registered prospectively from 2007 to 2011. The clinical guidelines were identified by searches of MEDLINE and websites of pediatric nephrology organizations.
Between centers, we found discrepancies in policies on: the minimum accepted recipient weight (8–12 kg), the maximum living and deceased donor age (50–75 and 45–60 years, respectively). HLA-match policies varied between acceptation of all mismatches to at least 1A1B1DR match donor transplantations amounting to 49 % in the Netherlands versus 26 % in Belgium (p = 0.006).
Management policies for renal Tx in children vary considerably between centers and nations. This has a direct impact on the delivered care, and by extrapolation, on health outcome.
KeywordsPediatric Renal transplantation Policies Guidelines
This study was performed on behalf of the RICH-Q Group. Other authors that contributed to this article are Antonia H. M. Bouts, Laure Collard, Maria van Dyck, Nathalie Godefroid, Koenraad van Hoeck, Christina Taylan, Linda Koster-Kamphuis, Marc R. Lilien, Ann Raes, and Nadedja Ranguelov. RICH-Q is mainly funded by the Dutch Kidney Foundation. Additional funding was provided by Astellas, Ferring Pharmaceuticals, Sanovi, Roche and Shire. The funders had no role in the design and conduct of the project, data gathering or interpretation, or in the preparation of the manuscript. We are grateful to all patients and the participating centers in the RICH-Q study and to Dr. Els Boeschoten, Lucia ten Brinke, Lara Heuveling, Martijn Leegte, and Helga Schrijvers from the Hans Mak Institute for their support with data registration and monitoring.
Conflict of interest
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