Kidney transplantation and other methods of renal replacement therapy in children: 30 years of observations in one center.

Background: Kidney transplantation (Tx) is regarded as the optimal treatment method for renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients. Children qualified for Tx should receive the organ as soon as possible in order to improve their chances for healthy development. In our center, RRT for children with ESRD has been conducted for 36 years: hemodialysis (HD) since 1982, peritoneal dialysis (PD) since 1992 and the first transplant in 1987.

Objectives: To analyze the rates of different RRT methods in children with ESRD. Special attention was paid to Tx.

Material And Methods: We compared the rates of RRT methods over 3 subsequent decades (1987-1996, 1997-2006 and 2007-2017).

Results: In the period analyzed, 153 children aged from 2 weeks to 18 years were dialyzed. The mean age of the start of RRT was 9.4 years. In 80 children (52.2%), first method was HD, while in 73 patients (47.7%) it was PD. In 25 children, the type of dialysis was changed. Kidney transplantation was performed in 40%, 60.34% and 73% of patients dialyzed in the periods 1987-1996, 1997-2006 and 2007-2017, respectively. The average waiting time for a transplant in the abovementioned decades was 2.25 years, 2.65 years and 1.97 years, respectively. Three children underwent transplantation with a family donor; 1 boy received a transplanted kidney and liver. Two children underwent a preemptive transplant from a deceased donor.

Conclusions: The percentage of children with ESRD treated with Tx continues to increase, but in our assessment, it still remains too low. Among the types of dialysis, PD was much more frequently used, which is consistent with pediatric recommendations. Small number of transplants from a living donor and preemptive transplants indicates the need to promote organ donation in Polish society.