CHAPTER 83: Epidemiology—Pediatric Kidney Transplantation

SECTION 1: INTRODUCTION1

Data from:

• https://adr.usrds.org/2020/end-stage-renal-disease/7-%20esrd-among-children-and-adolescents. Annual Data Report // End Stage Renal Disease // 7: ESRD among Children and Adolescents.¹

End Stage Renal Disease (ESRD) in children:

• Incidence: 11.5 per million population

• Adjusted mortality: 23.8 per thousand patient years

  • Cause of death:

    • ~25% cardiovascular

    • ~15% infectious

    • ~60% other

• Of adult survivors of childhood-onset ESRD:

  • ~50% have functioning index kidney transplant

  • ~22% have functioning subsequent transplant

END-STAGE RENAL DISEASE¹

The etiology of ESRD in children is different compared to that in adults, in whom acquired renal disease predominates

• In younger children, the leading cause of ESRD is congenital

• In older children and adolescents, primary and secondary glomerulonephritis (GN) are more prevalent

Causes of Pediatric ESRD¹

Manifestations of ESRD/Dialysis in Children

• Delayed physical growth

• Osteodystrophy

• Delayed puberty

• Diminished neurologic and cognitive function

• Increased somnolence and fatigue

• Hypertension

• Cardiomegaly

• Dyslipidemia

• Anemia

• Infections

• Dialysis access complications

• Psychosocial challenges

• Increased overall morbidity/mortality

SECTION 2: ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK (OPTN) AND SCIENTIFIC REGISTRY OF TRANSPLANT RECIPIENTS (SRTR) DATA^2,3,4

Data from:

https://www.srtr.org/reports/srtroptn-annual-data-report/²

Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR 2018 Annual data report: Kidney. Am J Transplant. 2020;20(Suppl s1):20–130. doi:10.1111/ajt.15672 ³

Hart A, Lentine KL, Smith JM, Miller JM, Skeans MA, Prentice M, Robinson A, Foutz J, Booker SE, Israni AK, Hirose R, Snyder JJ. OPTN/SRTR 2019 Annual Data Report: Kidney. Am J Transplant. 2021 Feb;21 Suppl 2:21–137. doi: 10.1111/ajt. 16502. PMID: 33595191 ⁴

Waitlist^2,3,4

• Candidates registered prior to age 18 receive priority in the organ allocation process

• Over 1000 waitlisted pediatric kidney transplant candidates

• Waitlist candidates:

  • <6 years of age: ~20%

  • 6-11 years of age: ~20%

  • 12-17 years of age: ~60%

• Approximately 25%-30% listed as active

  • Increase in candidates

    • 1–5 and 6–10 years of age

    • With a primary diagnosis of congenital anomalies of the kidney and urinary tract (most common among those aged < 6 years)

  • Decrease in candidates

    • 11–17 years of age

    • With a primary diagnosis of GN and focal segmental glomerulosclerosis (FSGS) (most common among those aged >6 years)

    • Waiting for a retransplant (~13%)

  • Most frequent reason for inactive status

    • Incomplete evaluation (51.4%)

    • Living donor (15.6%)

    • Too early to transplant (14.2%)

• ~70% of candidates have calculated panel reactive antibody (cPRA) <1%

• ~1.5% listed for multivisceral transplant

• Removal from waitlist

  • ~60% received deceased donor transplants

  • ~25% received live donor transplants

  • ~2% died

  • ~0.1% improved

  • ~0.1% too ill to ...