Trends in the epidemiology of paediatric kidney transplantation in Europe between 2010 and 2021: an ESPN/ERA Registry study

Background Kidney transplantation (KT) is the preferred treatment for paediatric patients with kidney failure, but information on trends in paediatric KT in Europe is lacking. We aimed to report on time trends in paediatric (0-17 years) KT rates and recipient characteristics in Europe between 2010 and 2021. Methods Thirty-one countries contributing data from 2010 to 2021 on paediatric KT to the European Society for Paediatric Nephrology/European Renal Association Registry were included. We reported trends in KT rates [per million age-related population (pmarp)], overall and by patient subgroup for Europe, and at macro-economic and country-specific levels. We also reported clinical variables in the first year post-KT. The 2020-21 period was analysed separately to account for the COVID-19 pandemic. Results The paediatric KT rate was stable at ≈5 pmarp between 2010 and 2019, and about one-fourth were pre-emptive KTs. In 2020-21 the KT rate was 5.6 pmarp. In low-, middle- and high-gross domestic product (GDP) countries, KT rates (pmarp) were 2.1, 6.1 and 7.6, respectively, and increased in low-GDP countries by 4.1% per year from 2010 to 2019, mainly in the youngest recipients. The proportion of pre-emptive KT increased only in middle-GDP countries. Low-GDP countries showed a higher prevalence of short stature while high-GDP countries showed more overweight/obese, hypertensive and anaemic patients. Conclusions The rate of paediatric KT in Europe has remained stable, with differences between GDP groups. Low-GDP countries had the lowest KT rates, but with an increasing trend over time. Opportunities to further increase access to paediatric KT should be explored.