title: The effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy.
abstract: BACKGROUND
  Controversy exists concerning the timing of the first kidney transplantation for children who need to start renal replacement therapy (RRT). Our aim was to estimate the effect of timing of the first transplantation on patient survival in children, for the first time also taking into account the mortality on dialysis before transplantation.
  
  
  METHODS
  We included 2091 patients who started RRT between the age of 3 and 18 years in the period 1988-2007, from 13 European renal registries. A multistate model was used to simulate patient survival assuming (i) pre-emptive transplantation, (ii) transplantation after 1 or 2 years on dialysis and (iii) remaining on dialysis.
  
  
  RESULTS
  Over the 20-year period, the highest 8-year survival probabilities were achieved in children transplanted pre-emptively {living donor (LD): 95.9% [95% confidence interval (CI): 93.1-98.8], deceased donor (DD): 95.3% (95% CI: 90.9-99.9)} rather than after 2 years of dialysis [LD: 94.2% (95% CI: 91.6-96.8), DD: 93.4% (95% CI: 91.0-95.9)], although these differences were not statistically significant.
  
  
  CONCLUSIONS
  Even after taking mortality on dialysis into account, the potentially negative effect of postponing transplantation for 1 or 2 years was relatively small and not statistically significant. Therefore, if pre-emptive transplantation is not possible, starting RRT with a short period of dialysis and receiving a transplant thereafter seems an acceptable alternative from the perspective of patient survival.
authors.affiliation: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. a.kramer@amc.uva.nl
authors.forename: Anneke
authors.initials: A
authors.lastname: Kramer
authors.forename: Vianda S
authors.initials: VS
authors.lastname: Stel
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Geskus
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Tizard
authors.forename: Enrico
authors.initials: E
authors.lastname: Verrina
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
authors.forename: James G
authors.initials: JG
authors.lastname: Heaf
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Leah
authors.initials: L
authors.lastname: Krischock
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Leivestad
authors.forename: Runólfur
authors.initials: R
authors.lastname: Pálsson
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality*; D017582:Renal Replacement Therapy / Q000401:mortality*; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors; D055815:Young Adult