Kidney Week

Abstract: SA-PO080

Trends in the Timing of Preemptive Kidney Transplantation in Children

Session Information

• Transplantation: Recipient and Donor Assessment
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Winnicki, Erica, UC San Francisco, San Francisco, California, United States

Erica Winnicki,

• Johansen, Kirsten L., UC San Francisco, San Francisco, California, United States

Kirsten L. Johansen,

• McCulloch, Charles E., UC San Francisco, San Francisco, California, United States

Charles E. McCulloch,

• Lee, Jason T., UC San Francisco, San Francisco, California, United States

Jason T. Lee,

• Ku, Elaine, UC San Francisco, San Francisco, California, United States

Elaine Ku,

Background

There has been a recent trend toward starting dialysis at higher levels of kidney function in children. Whether there has been a similar trend for preemptive kidney transplantation (PKT) in children is unknown.

Methods

We identified 3,278 children (age 1-17 years) in the US Renal Data System who underwent PKT between 1995 and 2015 and had data available to estimate glomerular filtration rate (eGFR) using the bedside Schwartz equation. We evaluated the trend in eGFR at time of PKT over time and differences in recipient characteristics between those who received PKT early (eGFR >10 ml/min/1.73m²) vs. late (eGFR ≤10 ml/min/1.73m²).

Results

Mean eGFR at the time of PKT increased significantly over time (Figure), from 9.1 ml/min/1.73m² in 1995 to 13.5 ml/min/1.73m² in 2015 (p<0.001). The trend toward earlier transplantation was similar among recipients of living and deceased donor organs (p for interaction=0.67). The proportion of children undergoing PKT early increased from 31% in 1995 to 71% in 2015. Overall, 57% of children underwent PKT early (mean eGFR 15.5 ml/min/1.73 m²). Compared to children who underwent PKT late (mean eGFR 7.5 ml/min/1.73 m²), those who were transplanted early were older, more often of white race, and less likely to have a living donor (Table).

Conclusion

PKT is occurring at higher levels of eGFR over time in children. Further studies should examine possible reasons for this trend and whether timing of PKT is associated with allograft survival or mortality.

Funding

• NIDDK Support