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Kidney Transplantation Without Prior Dialysis in Children: The Eurotransplant Experience

Kidney transplantation without prior dialysis may prevent dialysis‐associated morbidity. We analyzed the outcome of 1113 first kidney transplants in children performed between 1990 and 2000 in the Eurotransplant community. Enlistment for a deceased donor kidney before start of dialysis (127/895, 14%) made dialysis redundant in 55% of cases. Mean residual creatinine clearance at transplantation of these patients was 8 mL/min/1.73 m2. Pre‐emptive transplantations of deceased donor kidneys showed less acute rejections (52% vs. 37% rejection‐free at 3 years, p = 0.039), compared to transplantations following dialysis. The difference in graft survival between non‐dialyzed and dialyzed patients (82% vs. 69% at 6 year) did not reach statistical significance (p = 0.055). No differences were noted after living donor transplantation. Multivariate analysis showed that the period of transplantation was the strongest predictor of graft survival (p < 0.001). Congenital structural abnormalities such as primary kidney disease predominated in nondialyzed patients as compared to dialyzed patients (p < 0.001); this factor did not influence graft survival. Based on our conclusion that pre‐emptive transplantation is at least as good as post‐dialysis transplantation, as well as on quality of life arguments, we recommend to consider pre‐emptive transplantation in children with end‐stage renal failure.