Top

Published in:

01-06-2013 | Original Article

Policy variation in donor and recipient status in 11 pediatric renal transplantation centers

Authors: Maike van Huis, Nikki J. Schoenmaker, Jaap W. Groothoff, Johanna H. van der Lee, Karlien Cransberg, on behalf of the RICH-Q Group

Published in: Pediatric Nephrology | Issue 6/2013

Abstract

Background

Evidence-based guidelines for pediatric renal transplantation (Tx) are lacking. This may lead to unwanted treatment variations. We aimed to quantify the variation in treatment policies and its consequences in daily practice in 11 centers that provide renal Tx for children in three European countries.

Methods

We surveyed Tx policies in all ten centers in the Netherlands and Belgium and one center in Germany. We compared Tx policies with the therapies actually provided and with recommendations from available published guidelines and existing literature. Information on treatment policies was obtained by a questionnaire; information on care actually provided was registered prospectively from 2007 to 2011. The clinical guidelines were identified by searches of MEDLINE and websites of pediatric nephrology organizations.

Results

Between centers, we found discrepancies in policies on: the minimum accepted recipient weight (8–12 kg), the maximum living and deceased donor age (50–75 and 45–60 years, respectively). HLA-match policies varied between acceptation of all mismatches to at least 1A1B1DR match donor transplantations amounting to 49 % in the Netherlands versus 26 % in Belgium (p = 0.006).

Conclusions

Management policies for renal Tx in children vary considerably between centers and nations. This has a direct impact on the delivered care, and by extrapolation, on health outcome.

Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, Wolff ED, Davin JC, Heymans HS (2002) Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int 61:621–629PubMedCrossRef

McDonald SP, Craig JC (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350:2654–2662PubMedCrossRef

Heidotting NA, Ahlenstiel T, Kreuzer M, Franke D, Pape L (2012) The influence of low donor age, living related donation and pre-emptive transplantation on end-organ damage based on arterial hypertension after paediatric kidney transplantation. Nephrol Dial Transplant 27:1672–1676PubMedCrossRef

http://www.rich-q.nl/ (2012) RICH-Q. Renal Insufficiency in Children - Quality Assessment and Improvement

Tromp WF, Schoenmaker NJ, van der Lee JH, Adams B, Bouts AH, Collard L, Cransberg K, Van Damme-Lombaerts R, Godefroid N, van HK, Koster-Kamphuis L, Lilien MR, Raes A, Offringa M, Groothoff JW (2012) Important differences in management policies for children with end-stage renal disease in the Netherlands and Belgium—report from the RICH-Q study. Nephrol Dial Transplant 27:1984–1992PubMedCrossRef

Massey EK, Kranenburg LW, Zuidema WC, Hak G, Erdman RA, Hilhorst M, Ijzermans JN, Busschbach JJ, Weimar W (2010) Encouraging psychological outcomes after altruistic donation to a stranger. Am J Transplant 10:1445–1452PubMedCrossRef

Kasiske BL, Zeier MG, Chapman JR, Craig JC, Ekberg H, Garvey CA, Green MD, Jha V, Josephson MA, Kiberd BA, Kreis HA, McDonald RA, Newmann JM, Obrador GT, Vincenti FG, Cheung M, Earley A, Raman G, Abariga S, Wagner M, Balk EM (2010) KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int 77:299–311PubMedCrossRef

http://www.kidney.org/professionals/kdoqi (2012) National Kidney Foundation. Kidney Disease: Outcome Quality Initiative (KDOQI)

http://www.cari.org.au (2010) Caring for Australasians with Renal Impairment (CARI)

10.

http://www.renal.org (2011) The Renal Association

11.

Knoll GA, Blydt-Hansen TD, Campbell P, Cantarovich M, Cole E, Fairhead T, Gill JS, Gourishankar S, Hebert D, Hodsman A, House AA, Humar A, Karpinski M, Kim SJ, Mainra R, Prasad GV (2010) Canadian Society of Transplantation and Canadian Society of Nephrology commentary on the 2009 KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Kidney Dis 56:219–246PubMedCrossRef

12.

http://www.renalmd.org (2011) Renal Physicians Association

13.

http://www.ispd.org/ (2011) International Society for Peritoneal Dialysis

14.

European best practice guidelines for renal transplantation. Section IV: long-term management of the transplant recipient (2002) Nephrol Dial Transplant 17 Suppl 4:1–67

15.

http://www.hansmakinstituut.nl/ (2010) Hans Mak instituut

16.

http://www.eurotransplant.org/cms/ (2011) Eurotransplant Annual Report (2011)

17.

Binet I, Bock AH, Vogelbach P, Gasser T, Kiss A, Brunner F, Thiel G (1997) Outcome in emotionally related living kidney donor transplantation. Nephrol Dial Transplant 12:1940–1948PubMedCrossRef

18.

Chkhotua AB, Klein T, Shabtai E, Yussim A, Bar-Nathan N, Shaharabani E, Lustig S, Mor E (2003) Kidney transplantation from living-unrelated donors: comparison of outcome with living-related and cadaveric transplants under current immunosuppressive protocols. Urology 62:1002–1006PubMedCrossRef

19.

Dale-Shall AW, Smith JM, McBride MA, Hingorani SR, McDonald RA (2009) The relationship of donor source and age on short- and long-term allograft survival in pediatric renal transplantation. Pediatr Transplant 13:711–718PubMedCrossRef

20.

Humar A, Arrazola L, Mauer M, Matas AJ, Najarian JS (2001) Kidney transplantation in young children: should there be a minimum age? Pediatr Nephrol 16:941–945PubMedCrossRef

21.

Elshihabi I, Chavers B, Donaldson L, Emmett L, Tejani A (2000) Continuing improvement in cadaver donor graft survival in North American children: the 1998 annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant 4:235–246PubMedCrossRef

22.

Oppenheimer F, Aljama P, Asensio PC, Bustamante BJ, Crespo Albiach JF, Guirado PL (2004) The impact of donor age on the results of renal transplantation. Nephrol Dial Transplant 19(Suppl 3):iii11–iii15PubMedCrossRef

23.

Vivas CA, O’Donovan RM, Jordan ML, Hickey DP, Hrebinko R, Shapiro R, Starzl TE, Hakala TR, Jordan ML (1992) Cadaveric renal transplantation using kidneys from donors greater than 60 years old. Clin Transplant 6:77–80PubMed

24.

Cravedi P, Ruggenenti P, Remuzzi G (2011) Old donors for kidney transplantation: how old? Gerontology 57:513–520PubMedCrossRef

25.

Remuzzi G, Cravedi P, Perna A, Dimitrov BD, Turturro M, Locatelli G, Rigotti P, Baldan N, Beatini M, Valente U, Scalamogna M, Ruggenenti P (2006) Long-term outcome of renal transplantation from older donors. N Engl J Med 354:343–352PubMedCrossRef

26.

Barba J, Zudaire JJ, Robles JE, Tienza A, Rosell D, Berian JM, Pascual I (2011) Is there a safe cold ischemia time interval for the renal graft? Actas Urol Esp 35:475–480PubMedCrossRef

27.

Quiroga I, McShane P, Koo DD, Gray D, Friend PJ, Fuggle S, Darby C (2006) Major effects of delayed graft function and cold ischaemia time on renal allograft survival. Nephrol Dial Transplant 21:1689–1696PubMedCrossRef

28.

Shishido S, Hyodo YY, Aoki Y, Takasu J, Kawamura T, Sakai KK, Aikawa AA, Satou H, Muramatsu MM, Matsui Z (2012) Outcomes of pediatric ABO-incompatible kidney transplantations are equivalent to ABO-compatible controls. Transplant Proc 44:214–216PubMedCrossRef

29.

Grimshaw JM, Russell IT (1993) Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 342:1317–1322PubMedCrossRef

Title: Policy variation in donor and recipient status in 11 pediatric renal transplantation centers
Authors: Maike van Huis
Nikki J. Schoenmaker
Jaap W. Groothoff
Johanna H. van der Lee
Karlien Cransberg
on behalf of the RICH-Q Group
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: Pediatric Nephrology / Issue 6/2013
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-012-2396-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Policy variation in donor and recipient status in 11 pediatric renal transplantation centers

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2013

High-dose continuous renal replacement therapy for neonatal hyperammonemia

Hydronephrosis associated with ureteral wall thickness: Answer

Impact of platelet transfusions in children with post-diarrheal hemolytic uremic syndrome

Cardorenal syndrome: an emerging problem in pediatric critical care

Rhabdomyolysis and acute kidney injury in two children: Answers

Cardiovascular risk assessment in children with chronic kidney disease