title: Policy variation in donor and recipient status in 11 pediatric renal transplantation centers.
abstract: BACKGROUND
  Evidence-based guidelines for pediatric renal transplantation (Tx) are lacking. This may lead to unwanted treatment variations. We aimed to quantify the variation in treatment policies and its consequences in daily practice in 11 centers that provide renal Tx for children in three European countries.
  
  
  METHODS
  We surveyed Tx policies in all ten centers in the Netherlands and Belgium and one center in Germany. We compared Tx policies with the therapies actually provided and with recommendations from available published guidelines and existing literature. Information on treatment policies was obtained by a questionnaire; information on care actually provided was registered prospectively from 2007 to 2011. The clinical guidelines were identified by searches of MEDLINE and websites of pediatric nephrology organizations.
  
  
  RESULTS
  Between centers, we found discrepancies in policies on: the minimum accepted recipient weight (8-12 kg), the maximum living and deceased donor age (50-75 and 45-60 years, respectively). HLA-match policies varied between acceptation of all mismatches to at least 1A1B1DR match donor transplantations amounting to 49 % in the Netherlands versus 26 % in Belgium (p = 0.006).
  
  
  CONCLUSIONS
  Management policies for renal Tx in children vary considerably between centers and nations. This has a direct impact on the delivered care, and by extrapolation, on health outcome.
authors: Departments of Pediatric Nephrology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands.
authors: Maike
authors: M
authors: van Huis
authors: Nikki J
authors: NJ
authors: Schoenmaker
authors: Jaap W
authors: JW
authors: Groothoff
authors: Johanna H
authors: JH
authors: van der Lee
authors: Karlien
authors: K
authors: Cransberg
authors: Antonia H  M
authors: AH
authors: Bouts
authors: Laure
authors: L
authors: Collard
authors: Maria
authors: M
authors: van Dyck
authors: Nathalie
authors: N
authors: Godefroid
authors: Koenraad
authors: K
authors: van Hoeck
authors: Christina
authors: C
authors: Taylan
authors: Linda
authors: L
authors: Koster-Kamphuis
authors: Marc R
authors: MR
authors: Lilien
authors: Ann
authors: A
authors: Raes
authors: Nadedja
authors: N
authors: Ranguelov
mesh_terms: D000368:Aged; D001530:Belgium; D002648:Child; D005858:Germany; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D014019:Tissue Donors