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Bonthuis M, Cuperus L, Chesnaye NC, Akman S, Melgar AA, Baiko S, Bouts AH, Boyer O, Dimitrova K, Carmo CD, Grenda R, Heaf J, Jahnukainen T, Jankauskiene A, Kaltenegger L, Kostic M, Marks SD, Mitsioni A, Novljan G, Palsson R, Parvex P, Podracka L, Bjerre A, Seeman T, Slavicek J, Szabo T, Tönshoff B, Torres DD, Van Hoeck KJ, Ladfors SW, Harambat J, Groothoff JW, Jager KJ. Results in the ESPN/ERA-EDTA Registry suggest disparities in access to kidney transplantation but little variation in graft survival of children across Europe. Kidney Int 2020; 98:464-475. [PMID: 32709294 DOI: 10.1016/j.kint.2020.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 01/10/2023]
Abstract
One of the main objectives of the European health policy framework is to ensure equitable access to high-quality health services across Europe. Here we examined country-specific kidney transplantation and graft failure rates in children and explore their country- and patient-level determinants. Patients under 20 years of age initiating kidney replacement therapy from January 2007 through December 2015 in 37 European countries participating in the ESPN/ERA-EDTA Registry were included in the analyses. Countries were categorized as low-, middle-, and high-income based on gross domestic product. At five years of follow-up, 4326 of 6909 children on kidney replacement therapy received their first kidney transplant. Overall median time from kidney replacement therapy start to first kidney transplantation was 1.4 (inter quartile range 0.3-4.3) years. The five-year kidney transplantation probability was 48.8% (95% confidence interval: 45.9-51.7%) in low-income, 76.3% (72.8-79.5%) in middle-income and 92.3% (91.0-93.4%) in high-income countries and was strongly associated with macro-economic factors. Gross domestic product alone explained 67% of the international variation in transplantation rates. Compared with high-income countries, kidney transplantation was 76% less likely to be performed in low-income and 58% less likely in middle-income countries. Overall five-year graft survival in Europe was 88% and showed little variation across countries. Thus, despite large disparities transplantation access across Europe, graft failure rates were relatively similar. Hence, graft survival in low-risk transplant recipients from lower-income countries seems as good as graft survival among all (low-, medium-, and high-risk) graft recipients from high-income countries.
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Affiliation(s)
- Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Liz Cuperus
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Nicholas C Chesnaye
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Sema Akman
- Department of Pediatric Nephrology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Angel Alonso Melgar
- Department of Pediatric Nephrology, La Paz Children's Hospital, Madrid, Spain
| | - Sergey Baiko
- Department of Pediatrics, Belarusian State Medical University, Minsk, Belarus
| | - Antonia H Bouts
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Nephrology, Emma Children's Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands
| | - Olivia Boyer
- Pediatric Nephrology Department, Université de Paris, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kremena Dimitrova
- Nephrology and Hemodialysis Clinic, Department of Pediatrics, Medical University of Sofia, Sofia, Bulgaria
| | - Carmen do Carmo
- Department of Pediatric Nephrology, Hospital Pediátrico de Coimbra, Coimbra, Portugal
| | - Ryszard Grenda
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Lukas Kaltenegger
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Mirjana Kostic
- University Children's Hospital, Nephrology and Urology Departments, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andromachi Mitsioni
- Department of Nephrology, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Gregor Novljan
- Department of Pediatric Nephrology, University Medical Center Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Runolfur Palsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Paloma Parvex
- Department of Pediatrics, Division of Pediatric Nephrology, Geneva University Hospital, Geneva, Switzerland
| | - Ludmila Podracka
- Pediatric Department, Children's Hospital, Comenius University, Bratislava, Slovakia
| | - Anna Bjerre
- Divsion of Pedatrics and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Norway
| | - Tomas Seeman
- Department of Pediatrics and Biomedical Center, 2nd Faculty of Medicine and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Jasna Slavicek
- Division of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Zagreb, Zagreb, Croatia
| | - Tamas Szabo
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Diletta D Torres
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital "Giovanni XXIII," Bari, Italy
| | - Koen J Van Hoeck
- Department of Pediatric Nephrology, University Hospital Antwerp, Antwerp, Belgium
| | - Susanne Westphal Ladfors
- Department of Paediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jérôme Harambat
- Department of Pediatrics, Bordeaux University Hospital, Bordeaux Population Health Research Center UMR 1219, University of Bordeaux, Bordeaux, France
| | - Jaap W Groothoff
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Nephrology, Emma Children's Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands
| | - Kitty J Jager
- ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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