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Setting reasonable objectives for improving preemptive kidney transplantation rates in children

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Abstract

Background

This study aims to develop a method to estimate the potential of preemptive kidney transplantation (PKT) by identifying patients who were transplanted after a dialysis period (non-preemptive kidney transplantation (NPKT)) despite being medically suitable for PKT.

Methods

All children (< 18 years old) starting kidney replacement therapy (KRT) in France, between 2010 and 2016 and transplanted before December 31, 2017, were included. A propensity score (PS) of receiving PKT was estimated by multivariate logistic regression based on recipient medical characteristics. Healthcare use during the 24 months prior to KRT initiation was extracted from the French National Health Insurance database, and a pre-KRT follow-up of more than 18 months was considered sufficient to allow preemptive transplantation.

Results

Among 643 patients who started KRT, 149 (23.2%) were preemptively transplanted. Using PS stratification, among 391 NPKT patients, we identified 145 patients (37%) suitable for PKT, according to clinical characteristics. Mean age was 12.3 years, 67% were males, and 56% had urological abnormalities. Among those 145 patients, we identified 79 NPKT patients who started on dialysis despite early referral to a nephrologist (more than 18 months prior to KRT initiation).

Conclusions

This method estimates a potential of 228 (149 + 79) PKT (35%) among pediatric patients in France. A similar method could be used in adults or in other countries. Estimation of the rate of patients with CKD stage 5 medically suitable for PKT will be of interest for health policy makers when setting up objectives for improvement in preemptive kidney transplant access.

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Author information

Authors and Affiliations

  1. Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012, Paris, France

    Cyrielle Parmentier & Jean-Daniel Delbet

  2. REIN Registry, Agence de la Biomedecine, La Plaine Saint-Denis, France

    Cyrielle Parmentier, Mathilde Lassalle & Cécile Couchoud

  3. Pediatric Nephrology Unit, CHU de Nice-Hôpital, Nice, France

    Etienne Berard

  4. Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Lyon, France

    Justine Bacchetta

  5. Pediatric Nephrology Unit, CHU de Bordeaux, Bordeaux, France

    Jerome Harambat

  6. Pediatric Nephrology Unit, Robert-Debré Hospital, APHP, Paris, France

    Julien Hogan

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  1. Cyrielle Parmentier
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Correspondence to Cyrielle Parmentier.

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Institutional review boards or independent ethics committees reviewed and approved the study (CNIL number 903188).

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Parmentier, C., Lassalle, M., Berard, E. et al. Setting reasonable objectives for improving preemptive kidney transplantation rates in children. Pediatr Nephrol 35, 2353–2360 (2020). https://doi.org/10.1007/s00467-020-04653-w

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  • DOI: https://doi.org/10.1007/s00467-020-04653-w

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