Long-term patient and graft survival for children and young adults after kidney transplantation and re-transplantation – results from the ERA Registry
Year: 2026
Type: article
Study design: Observational Study
Abstract: Long-term outcomes after kidney re-transplantation in patients with childhood-onset kidney replacement therapy (KRT) are poorly characterized. Using European Renal Association Registry data, we studied 12,623 patients who started KRT before age 20 years and received one (n = 11,078), two (n = 2,962) or three (n = 718) kidney transplants (KTs) between 1978 and 2019. In this descriptive study, 5-, 10- and 15-year patient survival was 97, 94 and 90 % after first, 97, 95, 94 % after second and 96, 94, 92 % after third KT; corresponding graft survival was 79, 63, 50 %, 69, 52, 38 %, and 67, 51, 38 %, respectively. After first KT, mortality and graft failure risks were lower after pre-emptive transplantation (adjusted hazard ratio: 0.66 [95% CI 0.54-0.80] and 0.89 [0.82-0.97], respectively) and after living donor (LD) transplantation (0.71 [0.61-0.83] and 0.76 [0.70-0.81], respectively). Additionally, graft failure risk was higher between ages 10-24 years, and for patients with glomerulonephritis, metabolic diseases or recurrent nephropathies, and females. In re-transplants, LD and pre-emptive KTs (particularly for second KT) and prior graft survival > 5 years were associated with reduced graft failure. Overall, LD, pre-emptive transplantation, and durable prior grafts were associated with the best outcomes.
Authors: Evgenia Preka, Marjolein Bonthuis, Stephen D. Marks, Anneke Kramer, Vianda S. Stel, Lukas Buchwinkler, Belén Ponte, Anders Åsberg, Stella Stabouli, Jelena Stojanovic, Søren S. Sørensen, Ann Christin Gjerstad, María Herrero-Goñi, Olga Lucía Rodriguez Arévalo, Michel Tsimaratos, Viktorija Kuzema, Mårten Segelmark, Runolfur Palsson, Alberto Ortiz, Kitty J. Jager, Jérôme Harambat
Institutions: Hôpital Necker-Enfants Malades, Inserm, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Institut des Maladies Génétiques Imagine, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Great Ormond Street Hospital for Children NHS Foundation Trust, NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, Innsbruck Medical University, Universität Innsbruck, University Hospital of Geneva, Oslo University Hospital, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Universidad de Deusto, University of the Basque Country, Hospital de Cruces, Generalitat Valenciana, Universitat Politècnica de València, Agence de la Biomédecine, Pauls Stradiņš Clinical University Hospital, Riga Stradiņš University, Lund University, Skåne University Hospital, University of Iceland, National University Hospital of Iceland, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Bordeaux Population Health
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
OpenAlex ID: W7224137703