Likelihood of children with end-stage kidney disease in Europe to live with a functioning kidney transplant is mainly explained by nonmedical factors

Background Registry data can be used to assess associations between medical and health-policy factors and the likelihood of children on renal replacement therapy (RRT) to live with a functioning kidney transplant in Europe. Methods A survey questionnaire was distributed among renal registry represen...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2014-03, Vol.29 (3), p.453-459
Main Authors: Harambat, Jérôme, van Stralen, Karlijn J., Verrina, Enrico, Groothoff, Jaap W., Schaefer, Franz, Jager, Kitty J.
Format: Article
Language:English
Subjects:
Adolescent
Age Factors
Blood & organ donations
Child
Children & youth
Europe - epidemiology
Female
GDP
Gross Domestic Product
Health Care Surveys
Health Priorities
Health Services Accessibility
Health Services Needs and Demand
Healthcare Disparities
Hemodialysis
Humans
Kidney diseases
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - surgery
Kidney Transplantation - adverse effects
Kidney Transplantation - mortality
Kidney transplants
Kidneys
Linear Models
Male
Medicine
Medicine & Public Health
Multivariate Analysis
Needs Assessment
Nephrology
Odds Ratio
Original Article
Patients
Pediatrics
Population
Questionnaires
Registries
Renal replacement therapy
Risk Factors
Surveys and Questionnaires
Time Factors
Tissue and Organ Procurement
Tissue Donors - supply & distribution
Transplantation
Treatment Outcome
Urology
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Summary:Background Registry data can be used to assess associations between medical and health-policy factors and the likelihood of children on renal replacement therapy (RRT) to live with a functioning kidney transplant in Europe. Methods A survey questionnaire was distributed among renal registry representatives in 38 European countries, and additional data was obtained from the European Society for Pediatric Nephrology/European Renal Association–European Dialysis and Transplant Association (ESPN/ERA-EDTA) registry. Results Thirty-two countries with a pediatric RRT program responded. The median percentage of children by country on RRT with a functioning transplant was 62 % (interquartile range 39–77). One per million population increase in donation rate from deceased donors was associated with a 5 % increase in the percentage of functioning transplants; the existence of an intermediate and high pediatric priority policy doubled and tripled this percentage, respectively, compared with no priority, whereas an increase in living donor pediatric kidney transplant rate of one per million children was associated with a 14 % higher percentage of functioning transplants. The percentage of functioning transplants was also strongly associated with the gross domestic product (GDP). Conclusion Considerable variations exist in the percentages of prevalent pediatric RRT populations with functioning renal transplants across Europe. A macroeconomic indicator such as GDP is the most important determinant of these international differences. Efforts should be made for living donation programs and pediatric allocation priority to increase access to kidney transplantation for children.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-013-2665-7