Nephrology Dialysis Transplantation
Volume 27, Issue 6, 2012, Pages 2588-2593

Fewer pre-emptive renal transplantations and more rejections in immigrant children compared to native Dutch and Belgian children (Article) (Open Access)

Tromp W.F.* , Cransberg K. , Van Der Lee J.H. , Bouts A.H. , Collard L. , Van Damme-Lombaerts R. , Godefroid N. , Van Hoeck K.J. , Koster-Kamphuis L. , Lilien M.R. , Raes A. , Ranguelov N. , Groothoff J.W.
  • a Department of Paediatric Nephrology, Emma Children's Hospital Academic Medical Centre, Amsterdam, Netherlands
  • b Department of Paediatric Nephrology, Sophia Children's Hospital Erasmus Medical Centre, Rotterdam, Netherlands
  • c Department of Paediatric Clinical Epidemiology, Emma Children's Hospital Academic Medical Centre, Amsterdam, Netherlands
  • d Department of Paediatric Nephrology, Emma Children's Hospital Academic Medical Centre, Amsterdam, Netherlands
  • e Department of Paediatric Nephrology, University Hospital Liege, Liege, Belgium
  • f Department of Paediatric Nephrology, University Hospital Leuven, Leuven, Belgium
  • g Department of Paediatric Nephrology, University Louvain, Brussels, Belgium
  • h Department of Paediatric Nephrology, University Hospital Antwerp, Antwerp, Belgium
  • i Department of Paediatric Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
  • j Department of Paediatric Nephrology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
  • k Department of Paediatric Nephrology, University Hospital Ghent, Ghent, Belgium
  • l Department of Paediatric Nephrology, Hospital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
  • m Department of Paediatric Nephrology, Emma Children's Hospital Academic Medical Centre, Amsterdam, Netherlands

Abstract

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. © 2012 The Author.

Author Keywords

immigrants Children Pre-emptive transplantation Acute rejection episode Ethnicity

Index Keywords

Netherlands Netherlands Antilles immigrant Germany proportional hazards model living donor Living Donors survival rate Follow-Up Studies follow up Prospective Studies human Dutch corticosteroid cadaver donor Asia Middle East Ethnic Groups risk assessment ethnic group Turkey (republic) priority journal controlled study hazard ratio Humans prognosis Tissue and Organ Procurement Luxembourg Confidence interval Young Adult school child treatment duration ethnic difference graft rejection Adolescent graft survival Infant, Newborn male Treatment Outcome female Emigrants and Immigrants Infant HLA antigen Child, Preschool Africa HLA matching Belgium Article major clinical study Belgian Kidney Failure, Chronic graft recipient kidney failure Kidney Transplantation adult renal replacement therapy quantitative analysis basiliximab Suriname mycophenolic acid 2 morpholinoethyl ester cyclosporin tacrolimus kidney graft rejection Morocco Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84861863690&doi=10.1093%2fndt%2fgfr628&partnerID=40&md5=9af80936e489d81fa43e685740d0ecbb
DOI: 10.1093/ndt/gfr628
ISSN: 09310509
Cited by: 8
Original Language: English