Observational studyPediatric nephrology (Berlin, Germany)2026
Management of children and adolescents with failing kidney allografts-a review of current practice across Europe.
Observational study in Pediatric nephrology (Berlin, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
31 authors.
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Abstract
backgroundThe medical management of failing kidney allografts is poorly understood even in adult patients with wide variations in practice. We studied failing kidney allografts in European children and provided insights into their management, including cardiovascular, CKD management, and changes to immunosuppression.
methodsA 3-year (2020-2023) retrospective study of current practices in the management of children with failing kidney allografts (with at least 1 year of follow-up) was conducted. A failing kidney allograft was defined as an eGFR < 30 mL/min/1.73 m
resultsA total of 119 patients from 27 European centres were included. At the time of allograft failure, 76% of patients were hypertensive, with 69% on antihypertensive medication(s). Of patients, 12%, 65%, and 29% were hyperphosphatemic, anemic, or acidotic, respectively. Phosphate binders, vitamin D analogs, iron supplementation, erythropoietin-stimulating agents, and alkali supplementation were used in 36%, 78%, 58%, 46%, and 71%, respectively. A variable practice of changing immunosuppressive drugs (at variable time points) after allograft failure was observed. At last follow-up, 47% of patients still had residual transplant function, 46% were on dialysis, 6% were re-transplanted, and 1% had died.
conclusionsManagement of children with failing kidney allografts is complex and practice varies across Europe. Our study paves the way for prospective studies looking at the effects of optimal management of blood pressure and CKD-MBD on allograft survival and the effects of immunosuppression changes on prospects for re-transplantation.
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