Show simple item record

dc.contributor.authorKramer, Anneke
dc.contributor.authorStel, Vianda S
dc.contributor.authorGeskus, Ronald B
dc.contributor.authorTizard, E Jane
dc.contributor.authorVerrina, Enrico
dc.contributor.authorSchaefer, Franz
dc.contributor.authorHeaf, James G
dc.contributor.authorKramar, Reinhard
dc.contributor.authorKrischock, Leah
dc.contributor.authorLeivestad, Torbjørn
dc.contributor.authorPálsson, Runólfur
dc.contributor.authorRavani, Pietro
dc.contributor.authorJager, Kitty J
dc.date.accessioned2013-08-29T10:59:40Z
dc.date.available2013-08-29T10:59:40Z
dc.date.issued2012-03
dc.date.submitted2013-08-29
dc.identifier.citationNephrol. Dial. Transplant. 2012, 27(3):1256-64en_GB
dc.identifier.issn1460-2385
dc.identifier.pmid21865215
dc.identifier.doi10.1093/ndt/gfr493
dc.identifier.urihttp://hdl.handle.net/2336/300228
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links field.en_GB
dc.description.abstractControversy exists concerning the timing of the first kidney transplantation for children who need to start renal replacement therapy (RRT). Our aim was to estimate the effect of timing of the first transplantation on patient survival in children, for the first time also taking into account the mortality on dialysis before transplantation. We included 2091 patients who started RRT between the age of 3 and 18 years in the period 1988-2007, from 13 European renal registries. A multistate model was used to simulate patient survival assuming (i) pre-emptive transplantation, (ii) transplantation after 1 or 2 years on dialysis and (iii) remaining on dialysis. Over the 20-year period, the highest 8-year survival probabilities were achieved in children transplanted pre-emptively {living donor (LD): 95.9% [95% confidence interval (CI): 93.1-98.8], deceased donor (DD): 95.3% (95% CI: 90.9-99.9)} rather than after 2 years of dialysis [LD: 94.2% (95% CI: 91.6-96.8), DD: 93.4% (95% CI: 91.0-95.9)], although these differences were not statistically significant. Even after taking mortality on dialysis into account, the potentially negative effect of postponing transplantation for 1 or 2 years was relatively small and not statistically significant. Therefore, if pre-emptive transplantation is not possible, starting RRT with a short period of dialysis and receiving a transplant thereafter seems an acceptable alternative from the perspective of patient survival.
dc.description.sponsorshipEuropean Renal Association-European Dialysis and Transplant Association (ERA EDTA)en_GB
dc.language.isoenen
dc.relation.urlhttp://dx.doi.org/10.1093/ndt/gfr493en_GB
dc.rightsArchived with thanks to Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Associationen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshChilden_GB
dc.subject.meshChild, Preschoolen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshKidney Failure, Chronicen_GB
dc.subject.meshKidney Transplantationen_GB
dc.subject.meshMaleen_GB
dc.subject.meshPrognosisen_GB
dc.subject.meshRenal Dialysisen_GB
dc.subject.meshRenal Replacement Therapyen_GB
dc.subject.meshSurvival Rateen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshTissue Donorsen_GB
dc.subject.meshYoung Adulten_GB
dc.titleThe effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy.en
dc.typeArticleen
dc.contributor.departmentERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.en_GB
dc.identifier.journalNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Associationen_GB
dc.rights.accessClosed - Lokaðen
html.description.abstractControversy exists concerning the timing of the first kidney transplantation for children who need to start renal replacement therapy (RRT). Our aim was to estimate the effect of timing of the first transplantation on patient survival in children, for the first time also taking into account the mortality on dialysis before transplantation. We included 2091 patients who started RRT between the age of 3 and 18 years in the period 1988-2007, from 13 European renal registries. A multistate model was used to simulate patient survival assuming (i) pre-emptive transplantation, (ii) transplantation after 1 or 2 years on dialysis and (iii) remaining on dialysis. Over the 20-year period, the highest 8-year survival probabilities were achieved in children transplanted pre-emptively {living donor (LD): 95.9% [95% confidence interval (CI): 93.1-98.8], deceased donor (DD): 95.3% (95% CI: 90.9-99.9)} rather than after 2 years of dialysis [LD: 94.2% (95% CI: 91.6-96.8), DD: 93.4% (95% CI: 91.0-95.9)], although these differences were not statistically significant. Even after taking mortality on dialysis into account, the potentially negative effect of postponing transplantation for 1 or 2 years was relatively small and not statistically significant. Therefore, if pre-emptive transplantation is not possible, starting RRT with a short period of dialysis and receiving a transplant thereafter seems an acceptable alternative from the perspective of patient survival.


This item appears in the following Collection(s)

Show simple item record