ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
Am J Transplant. 2013 Aug;13(8):2066-74. doi: 10.1111/ajt.12288. Epub 2013 May 29.
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.
我们旨在概述欧洲与儿童相关的肾脏分配政策以及儿科肾移植（KTx）的实践和比例，并研究与 KTx 比例相关的因素。一项调查分发给了 38 个欧洲国家的肾脏登记处代表。其他数据来自 ESPN/ERA-EDTA 和 ERA-EDTA 登记处。32 个国家（84%）做出了回应。儿科 KTx 的中位发生率为每百万儿童（pmc）5.7 例（范围 0-13.5）。中位比例为 17%（四分位距 2-29）的 KTx 是预先进行的，而中位比例为 43%（四分位距 10-52）的 KTx 是活体供者 KTx。中位百分比的儿童在接受肾替代治疗（RRT）时有功能移植物为 62%。儿科优先级别与已故供体 KTx 的等待时间缩短、儿科 KTx 比例增加以及活体供者 KTx 比例降低有关。欧洲国家之间的儿科 KTx 比例、供体来源分布和等待时间差异很大。儿童肾脏分配缺乏协调引发了医学和伦理问题。应优先协调儿科分配政策。
