Paediatric kidney transplantation in Belgium.
In Belgium, kidney transplantation is currently the treatment of choice for a child with end-stage renal disease (ESRD). Dialysis remains the life-saving bridge to transplantation. Within the Eurotransplant (ET) community, Belgium represents 14% of the cadaveric transplantations and 22% of the living-related transplantation (LD) in children less than 16 years of age. Single-centre analysis (KUL) shows a patient survival of 94% at 3 year and 91% at 5 year. The overall graft survival is 82% at 3 year and 74% at 5 year. In the LD group, the graft survival rate is 10% better than the overall actuarial graft survival rate. Multivariate Cox regression analysis performed on all transplantations of one centre (KUL) demonstrate the following factors to be significant and independent predictors of poor graft outcome: absence of calcineurin inhibitors, two HLA- mismatches, duration of pre-transplant dialysis and creatinine clearance at one year after transplantation. The outcome improves by a short dialysis waiting time, the use of living-related donors, the prevention of delayed graft function (DGF), and of acute rejection. Within the ET community, the waiting child has priority compared to the adult, but if we want to avoid morbidity, waiting times must be shortened and the incidence of pre-emptive transplantation, which is currently 24% in Belgium, must increase. The good results with LD is certainly an attractive alternative to be actively encouraged for paediatric kidney recipients and the use of young deceased donors especially for children with ESRD must be supported since the results in terms of graft survival with these donors are very good, especially in children. In paediatric kidney transplantation the long-term graft survival is still the major challenge and has still to be documented by randomized trials. The success of the past, however, allows us to face the future with hope and confidence.
Van Damme-Lombaerts
R
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Department of Pediatric Nephrology and Solid Organ Transplantation, University Hospital Leuven, Belgium. rita.lombaerts@uz.kuleuven.be
D001530:Belgium; D002648:Child; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000453:epidemiology*; D009927:Tissue and Organ Procurement / Q000458:organization & administration*