Adolescent; Adult; Belgium; Child; Child, Preschool; Emigrants and Immigrants/statistics & numerical data; Ethnic Groups; Female; Follow-Up Studies; Graft Rejection/etiology/mortality; Graft Survival; Humans; Infant; Infant, Newborn; Kidney Failure, Chronic/complications/ethnology/mortality; Kidney Transplantation/adverse effects; Living Donors; Male; Netherlands; Prognosis; Prospective Studies; Survival Rate; Tissue and Organ Procurement; Young Adult
Abstract :
[en] BACKGROUND: In the Netherlands and Belgium, an increasing number of children who have end-stage renal disease (ESRD) are of non-Western origin. We analysed renal transplantation practices and outcome for immigrant ESRD children as compared to native children in both countries. METHODS: All Dutch and Belgian children aged <19 years who received their first renal transplantation between 1 September 2007 and 1 January 2011 were included. Therapy characteristics and outcomes were registered prospectively on a 3-monthly basis. Immigrants were defined as children of whom one or both parents had been born outside Western European countries. Multivariable Cox regression analysis was used to quantify the hazard ratio for acute rejection. RESULTS: One hundred and nineteen first renal transplant recipients were included, of which 41 (34%) were immigrants. Median [range] follow-up time of transplantation was 18 [2-28] months. Compared to native children, immigrants had pre-emptive transplantations (15 versus 32%, P = 0.040) and transplantations with a kidney from a living donor less often (24 versus 59%, P < 0.001). Survival analysis in 96 children with at least 3 months of follow-up showed an increased risk for acute rejection in immigrants adjusted for donor source, duration of dialysis and number of HLA mismatches on the DR locus [hazard ratio (95% confidence interval) 2.5 (1.1-5.9)]. CONCLUSIONS: Immigrant children receive fewer pre-emptive and living donor transplantations compared to native children. After transplantation, immigrant children are at higher risk for acute rejection irrespective of the mode of transplantation.
Disciplines :
Pediatrics Urology & nephrology
Author, co-author :
Tromp, Wilma F.
Cransberg, Karlien
van der Lee, Johanna H.
Bouts, Antonia H.
COLLARD, Laure ; Centre Hospitalier Universitaire de Liège - CHU > Pédiatrie CHR
Centraal Bureau voor de Statistiek. 2011. ; http://www.cbs.nl (1 May 2011, date last accessed)
Statistics Belgium. http://statbel.fgov.be (1 August 2010, date last accessed)
Stronks K, Ravelli AC, Reijneveld SA. Immigrants in the Netherlands: equal access for equal needs? J Epidemiol Community Health 2001; 55: 701-707
van Dellen QM, Stronks K, Bindels PJ et al. Predictors of asthma control in children from different ethnic origins living in Amsterdam. Respir Med 2007; 101: 779-785
Renal Insufficiency therapy in Children-Quality Assessment and Improvement. 2010. http://www.rich-q.nl/(13 December 2010, date last accessed)
Schwartz GJ, Munoz A, Schneider MF et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009; 20: 629-637
Cransberg K, Smits JM, Offner G et al. Kidney transplantation without prior dialysis in children: the Eurotransplant experience. Am J Transplant 2006; 6: 1858-1864
Park CW, Limm WM, Wong LL. Improving living renal transplant: lessons from a multi-ethnic transplant program. Hawaii Med J 2009; 68: 104-108
Chan KS, Keeler E, Schonlau M et al. How do ethnicity and primary language spoken at home affect management practices and outcomes in children and adolescents with asthma? Arch Pediatr Adolesc Med 2005; 159: 283-289
Rong G, Jing L, Deng-Qing L et al. Influence of CYP3A5 and MDR1(ABCB1) polymorphisms on the pharmacokinetics of tacrolimus in Chinese renal transplant recipients. Transplant Proc 2010; 42: 3455-3458
Hesselink DA, van Schaik RH, van der Heiden IP et al. Genetic polymorphisms of the CYP3A4, CYP3A5, and MDR-1 genes and pharmacokinetics of the calcineurin inhibitors cyclosporine and tacrolimus. Clin Pharmacol Ther 2003; 74: 245-254
Emovon OE, Op't HC, Browne BJ. Can a pharmacokinetic approach to immunosuppression eliminate ethnic disparities in renal allograft outcome? Clin Transplant 2002; 16 (Suppl 7): 45-48
Oztek FZ, Tekin P, Herle M et al. Does immigration background influence outcomes after renal transplantation? Pediatr Nephrol 2011; 26: 309-315
Roodnat JI, Zietse R, Rischen-Vos J et al. Renal graft survival in native and non-native European recipients. Transpl Int 1999; 12: 135-140
van den Beukel TO, Dekker FW, Siegert CE. Increased survival of immigrant compared to native dialysis patients in an urban setting in the Netherlands. Nephrol Dial Transplant 2008; 23: 3571-3577