Аңдатпа
INTRODUCTION: Mortality rates in children receiving renal replacement therapy (RRT) are much higher than the age and sex matched general population. Transplanted children have better survival and quality of life compared to children receiving haemodialysis (HD) or peritoneal dialysis (PD). ESPN/ERA-EDTA registry reported one- and five-year survival of transplanted children in Europe to be 96.6% and 89.5%, respectively. Limited data are available about long-term outcomes of children after kidney transplantation from developing countries. Paediatric kidney transplant program in Kazakhstan was launched in 2012 in Astana. Therefore, the aim of this study is to describe demographics, long-term patient, and graft survival of children after kidney transplantation in Kazakhstan. METHODS: We included children who received a kidney transplant at <18 years of age (N=70) between 2012 and 2018 in the National Research Centre of Maternal and Child Health, Astana, Kazakhstan, which has a national coverage. One-year follow-up data were available for all children. To describe three-year patient and graft survival we included children who received a kidney transplant between 2012 and 2015 (N=29). To describe five-year patient and graft survival we included children who received a kidney transplant between 2012 and 2013 (N=9). We used Cox regression analysis to describe associations of primary renal disease (PRD) and donor source with graft failure. RESULTS: Mean age of the transplanted children was 11.4 years (Standard Deviation (SD) 4.3). Girls accounted for 50% of all recipients (n=35). The main primary renal diseases which caused ESRD were congenital anomalies of the kidney and urinary tract (CAKUT) (51.4%) and glomerulonephritis (31.4%). 47 patients (67.1%) received a kidney transplant of the living donor from their relatives, while 23 children (32.9%) received a renal transplant from a deceased donor. Majority of children (54.3 %) started on PD, 25.7% - on HD, and 20% received pre-emptive transplantation. Median time spent on dialysis before receiving a kidney transplant was 0.9 years (interquartile range (IQR) 0.5-1.6). All children underwent standard immunosuppressive therapy consisted of induction therapy with monoclonal antibodies (Basiliximab (Simulect)) or Anti-thymocyte immunoglobulin (Thymoglobuline) and maintenance therapy with Calcineurin inhibitors, Mycophenolate mofetil and glucocorticoids. Median follow-up time was 2.2 years (IQR 1.1-3.8) resulting in total of 177 patient-years. Four patients died. Crude mortality rate was 2.2 per 100 patient-years. Graft loss occurred in 9 children. One-year patient and graft survival was 95.7% and 90.0% respectively. Three-year patient and graft survival was 93.0% and 82.8% respectively. Five-year patient and graft survival was 88.0% and 77.8% respectively. Patients with non-CAKUT PRD had an adjusted 5.48 (95% CI 1.04; 28.8) times higher risk of graft failure compared to patients with CAKUT. Deceased donor recipients had an adjusted 3.97 (1.00; 17.6) times higher risk of graft failure compared to living donor recipients. CONCLUSIONS: All the efforts that have been made for the implementation of the paediatric transplantation program in Kazakhstan have been successful and the results are comparable to European countries. PRD is significant determinant for graft failure in transplanted children.