title: Disparities in policies, practices and rates of pediatric kidney transplantation in Europe.
abstract: We aimed to provide an overview of kidney allocation policies related to children and pediatric kidney transplantation (KTx) practices and rates in Europe, and to study factors associated with KTx rates. A survey was distributed among renal registry representatives in 38 European countries. Additional data were obtained from the ESPN/ERA-EDTA and ERA-EDTA registries. Thirty-two countries (84%) responded. The median incidence rate of pediatric KTx was 5.7 (range 0-13.5) per million children (pmc). A median proportion of 17% (interquartile range 2-29) of KTx was performed preemptively, while the median proportion of living donor KTx was 43% (interquartile range 10-52). The median percentage of children on renal replacement therapy (RRT) with a functioning graft was 62%. The level of pediatric prioritization was associated with a decreased waiting time for deceased donor KTx, an increased pediatric KTx rate, and a lower proportion of living donor KTx. The rates of pediatric KTx, distribution of donor source and time on waiting list vary considerably between European countries. The lack of harmonization in kidney allocation to children raises medical and ethical issues. Harmonization of pediatric allocation policies should be prioritized.
authors.affiliation: ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands. jerome.harambat@chu-bordeaux.fr
authors.forename: J
authors.initials: J
authors.lastname: Harambat
authors.forename: K J
authors.initials: KJ
authors.lastname: van Stralen
authors.forename: F
authors.initials: F
authors.lastname: Schaefer
authors.forename: R
authors.initials: R
authors.lastname: Grenda
authors.forename: A
authors.initials: A
authors.lastname: Jankauskiene
authors.forename: M
authors.initials: M
authors.lastname: Kostic
authors.forename: M-A
authors.initials: MA
authors.lastname: Macher
authors.forename: H
authors.initials: H
authors.lastname: Maxwell
authors.forename: Z
authors.initials: Z
authors.lastname: Puretic
authors.forename: A
authors.initials: A
authors.lastname: Raes
authors.forename: J
authors.initials: J
authors.lastname: Rubik
authors.forename: S S
authors.initials: SS
authors.lastname: Sørensen
authors.forename: U
authors.initials: U
authors.lastname: Toots
authors.forename: R
authors.initials: R
authors.lastname: Topaloglu
authors.forename: B
authors.initials: B
authors.lastname: Tönshoff
authors.forename: E
authors.initials: E
authors.lastname: Verrina
authors.forename: K J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004608:Eligibility Determination; D005060:Europe; D005260:Female; D033161:Government Regulation; D006084:Graft Rejection; D006085:Graft Survival; D015276:Health Care Rationing / Q000331:legislation & jurisprudence; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data* / Q000639:trends*; D008297:Male; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D012042:Registries; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data; D014850:Waiting Lists; D055815:Young Adult
keywords: Children; health policy; kidney transplantation; organ allocation