Bonthuis Marjolein, Cuperus Liz, Chesnaye Nicholas C, Akman Sema, Melgar Angel Alonso, Baiko Sergey, Bouts Antonia H, Boyer Olivia, Dimitrova Kremena, Carmo Carmen do, Grenda Ryszard, Heaf James, Jahnukainen Timo, Jankauskiene Augustina, Kaltenegger Lukas, Kostic Mirjana, Marks Stephen D, Mitsioni Andromachi, Novljan Gregor, Palsson Runolfur, Parvex Paloma, Podracka Ludmila, Bjerre Anna, Seeman Tomas, Slavicek Jasna, Szabo Tamas, Tönshoff Burkhard, Torres Diletta D, Van Hoeck Koen J, Ladfors Susanne Westphal, Harambat Jérôme, Groothoff Jaap W, Jager Kitty J
ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
ESPN/ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
Kidney Int. 2020 Aug;98(2):464-475. doi: 10.1016/j.kint.2020.03.029. Epub 2020 Apr 26.
One of the main objectives of the European health policy framework is to ensure equitable access to high-quality health services across Europe. Here we examined country-specific kidney transplantation and graft failure rates in children and explore their country- and patient-level determinants. Patients under 20 years of age initiating kidney replacement therapy from January 2007 through December 2015 in 37 European countries participating in the ESPN/ERA-EDTA Registry were included in the analyses. Countries were categorized as low-, middle-, and high-income based on gross domestic product. At five years of follow-up, 4326 of 6909 children on kidney replacement therapy received their first kidney transplant. Overall median time from kidney replacement therapy start to first kidney transplantation was 1.4 (inter quartile range 0.3-4.3) years. The five-year kidney transplantation probability was 48.8% (95% confidence interval: 45.9-51.7%) in low-income, 76.3% (72.8-79.5%) in middle-income and 92.3% (91.0-93.4%) in high-income countries and was strongly associated with macro-economic factors. Gross domestic product alone explained 67% of the international variation in transplantation rates. Compared with high-income countries, kidney transplantation was 76% less likely to be performed in low-income and 58% less likely in middle-income countries. Overall five-year graft survival in Europe was 88% and showed little variation across countries. Thus, despite large disparities transplantation access across Europe, graft failure rates were relatively similar. Hence, graft survival in low-risk transplant recipients from lower-income countries seems as good as graft survival among all (low-, medium-, and high-risk) graft recipients from high-income countries.
欧洲卫生政策框架的主要目标之一是确保全欧洲民众都能公平获得高质量的医疗服务。在此，我们研究了各国儿童肾移植及移植失败率，并探讨了其国家层面和患者层面的决定因素。分析纳入了2007年1月至2015年12月期间在参与ESPN/ERA-EDTA注册中心的37个欧洲国家开始接受肾脏替代治疗的20岁以下患者。根据国内生产总值，将这些国家分为低收入、中等收入和高收入国家。在随访的五年中，6909名接受肾脏替代治疗的儿童中有4326名接受了首次肾移植。从开始肾脏替代治疗到首次肾移植的总体中位时间为1.4年（四分位间距0.3 - 4.3年）。低收入国家的五年肾移植概率为48.8%（95%置信区间：45.9 - 51.7%），中等收入国家为76.3%（72.8 - 79.5%），高收入国家为92.3%（91.0 - 93.4%），且与宏观经济因素密切相关。仅国内生产总值就解释了移植率国际差异的67%。与高收入国家相比，低收入国家进行肾移植的可能性低76%，中等收入国家低58%。欧洲的总体五年移植肾存活率为88%，各国之间差异不大。因此，尽管欧洲各国在移植可及性方面存在巨大差异，但移植失败率相对相似。所以，低收入国家低风险移植受者的移植肾存活率似乎与高收入国家所有（低、中、高风险）移植受者的移植肾存活率一样好。
