Introduction: Despite major technical improvement in the care of children requiring renal replacement therapy (RRT) before two years of age, the management of those patients remains challenging and transplantation is generally delayed until the child weighs 10 kg or is 2-year-old. In this national cohort study, we aim at studying patient and graft survival in children starting RRT before two years of age to help clinicians and parents when deciding on RRT initiation and transplantation management.

Methods: All children starting RRT before 24 months old between 1992 and 2012 in France were included through the national ESRD registry (REIN). The primary endpoints were patient survival on dialysis and 10-year graft survival.

Results: 224 patients were included (62% boys, median age 10.5months [5.8-15.6]). Ten-year survival rate was 84% [77-89]. Suffering from extra-renal comorbidities was the only factor significantly associated with both an increased risk of death on dialysis (HR 5.9, 95%CI [1.8-19.3]) and a decrease probability of being transplanted. During follow-up 174 renal transplantations were performed in 159 patients (median age at first transplantation 30.2 [21.8-40.7] months). Ten years' graft survival was 74% [67-81]. Factors associated with graft loss in multivariate analysis were the time spent on dialysis before transplantation, donor/recipient height ratio with an increased risk for both small and tall donors and presenting 2 HLA-DR mismatches.

Conclusion: This study confirms the good outcome of children starting RRT before two years of age. The main question remains when and how to transplant those children. Our study provides data on the optimal morphological and immunological matching in order to help clinicians in their decisions.

CITATION INFORMATION: Hogan J., Harambat J., Berard E., Couchoud C., Macher M-.A. Patient and Transplant Outcome in Infants Starting Renal Replacement Therapy before Two Years of Age Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress