Paediatric Nephrology Department, Starship Children's Hospital, Auckland, New Zealand.
J Paediatr Child Health. 2021 Sep;57(9):1490-1497. doi: 10.1111/jpc.15533. Epub 2021 May 7.
Pre-emptive kidney transplantation (PKT) is generally considered the optimal treatment for kidney failure as it minimises dialysis-associated morbidity and mortality and is associated with improved allograft survival. This study aimed to determine rates of paediatric PKT in New Zealand, identify barriers to PKT and consider potential interventions to influence future rates of pre-emptive transplantation.
Children commencing kidney replacement therapy between 2005 and 2017 in New Zealand were included. Descriptive analysis considered those referred late (referral <3 months prior to kidney replacement therapy initiation) or early based on referral timing to paediatric nephrology. Additional analysis compared characteristics of children receiving dialysis versus pre-emptive transplant as their first mode of kidney replacement therapy.
PKT occurred in 15 of 90 children (17%). One-third of all patients were referred late. No late referrals received a pre-emptive transplant. Pre-emptively transplanted children were referred younger (median age 0.49 years), lived in less deprived areas, were more likely to have congenital anomalies of the kidney and urinary tract and none were Māori or Pasifika ethnicity.
Late referral, higher deprivation levels and Māori and Pasifika ethnicity confer a greater risk of not receiving pre-emptive transplantation. Improved education amongst health professionals about recognition of paediatric chronic kidney disease and the importance of timely referral to paediatric nephrology is recommended to reduce rates of late referral. A modified approach including enhanced culturally appropriate support for those diagnosed with chronic kidney disease during transplant evaluation should be pursued to improve equity.
抢先进行肾移植（PKT）通常被认为是治疗肾衰竭的最佳方法，因为它可以最大限度地减少透析相关的发病率和死亡率，并提高移植物的存活率。本研究旨在确定新西兰小儿 PKT 的发生率，确定 PKT 的障碍，并考虑潜在的干预措施来影响未来抢先移植的比率。
纳入 2005 年至 2017 年间在新西兰开始接受肾脏替代治疗的儿童。描述性分析考虑了那些根据转介到儿科肾病学的时间而被晚期（转介时间<3 个月之前开始肾脏替代治疗）或早期转介的患者。此外，还比较了接受透析与抢先移植作为其首次肾脏替代治疗模式的儿童的特征。
90 名儿童中有 15 名（17%）接受了 PKT。三分之一的患者被晚期转介。没有晚期转介的患者接受了抢先移植。抢先移植的儿童转介时年龄更小（中位数年龄为 0.49 岁），生活在较不贫困的地区，更有可能患有先天性肾和尿路畸形，且均不是毛利人或太平洋岛民。
晚期转介、更高的贫困水平以及毛利人和太平洋岛民的种族与未接受抢先移植的风险增加相关。建议加强卫生专业人员对小儿慢性肾脏病的认识，并及时转介到儿科肾病学的教育，以降低晚期转介的比率。应采取改良的方法，包括在移植评估期间为诊断出患有慢性肾脏病的患者提供增强的文化适宜性支持，以提高公平性。
