Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP.6, 75012, Paris, France.
REIN Registry, Agence de la Biomedecine, La Plaine Saint-Denis, France.
Pediatr Nephrol. 2020 Dec;35(12):2353-2360. doi: 10.1007/s00467-020-04653-w. Epub 2020 Jun 25.
This study aims to develop a method to estimate the potential of preemptive kidney transplantation (PKT) by identifying patients who were transplanted after a dialysis period (non-preemptive kidney transplantation (NPKT)) despite being medically suitable for PKT.
All children (< 18 years old) starting kidney replacement therapy (KRT) in France, between 2010 and 2016 and transplanted before December 31, 2017, were included. A propensity score (PS) of receiving PKT was estimated by multivariate logistic regression based on recipient medical characteristics. Healthcare use during the 24 months prior to KRT initiation was extracted from the French National Health Insurance database, and a pre-KRT follow-up of more than 18 months was considered sufficient to allow preemptive transplantation.
Among 643 patients who started KRT, 149 (23.2%) were preemptively transplanted. Using PS stratification, among 391 NPKT patients, we identified 145 patients (37%) suitable for PKT, according to clinical characteristics. Mean age was 12.3 years, 67% were males, and 56% had urological abnormalities. Among those 145 patients, we identified 79 NPKT patients who started on dialysis despite early referral to a nephrologist (more than 18 months prior to KRT initiation).
This method estimates a potential of 228 (149 + 79) PKT (35%) among pediatric patients in France. A similar method could be used in adults or in other countries. Estimation of the rate of patients with CKD stage 5 medically suitable for PKT will be of interest for health policy makers when setting up objectives for improvement in preemptive kidney transplant access.
本研究旨在通过识别那些尽管在医学上适合进行预先肾移植（PKT）但仍在透析期后接受移植的患者，来开发一种估计预先肾移植（PKT）潜力的方法。
纳入了所有在 2010 年至 2016 年期间在法国开始肾脏替代治疗（KRT）且在 2017 年 12 月 31 日前接受移植的年龄<18 岁的儿童。根据受体的医学特征，通过多变量逻辑回归来估计接受 PKT 的倾向评分（PS）。从法国国家健康保险数据库中提取 KRT 开始前 24 个月的医疗保健使用情况，并且认为 KRT 前的随访时间超过 18 个月足以允许进行预先移植。
在开始 KRT 的 643 名患者中，有 149 名（23.2%）被预先移植。使用 PS 分层，在 391 名非 PKT 患者中，根据临床特征，我们确定了 145 名（37%）适合 PKT 的患者。平均年龄为 12.3 岁，67%为男性，56%有泌尿系统异常。在这 145 名患者中，我们发现有 79 名非 PKT 患者尽管很早就转介给了肾病医生（KRT 开始前超过 18 个月），但仍开始接受透析治疗。
这种方法估计法国儿科患者中有 228 名（149+79）潜在 PKT（35%）。在成人或其他国家也可以使用类似的方法。当制定提高预先肾移植机会的目标时，设定 CKD 5 期患者的医学适宜性进行 PKT 的患者比例将对卫生政策制定者具有重要意义。
