{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T20:56:12Z","timestamp":1793912172123,"version":"4.8.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T00:00:00Z","timestamp":1739404800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"European Renal Association"},{"name":"European Society for Paediatric Nephrology"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and hypothesis<\/jats:title>\n                  <jats:p>Knowledge regarding access to first kidney transplantation (KT) and subsequent KT in patients commencing kidney replacement therapy (KRT) in childhood is limited.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using European Renal Association (ERA) Registry data, we investigated European patients who started KRT below 20 years of age between 1978 and 2019. Access and determinants to first, second, and third KT were assessed using multivariable Cox regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Totals of 12\u2009623, 4077, and 1186 patients were included while awaiting first, second, and third KT, at median ages of 13.8 (IQR: 7.5\u201317.4), 20.9 (IQR: 16.5\u201326.1), and 26.6 (IQR: 20.3\u201332.8) years, respectively. During the study period, overall access was 87.8%, 72.7%, and 60.5% for first, second, and third KT, respectively, and median time to each KT was 0.9 (IQR: 0.2\u20132.1), 1.9 (0.6\u20134.5), and 2.6 (IQR: 1.0\u20135.3) years. Younger age at KRT initiation (aHR 0-4\u00a0vs. 10\u201314 years: 0.54; 95%CI: 0.51\u20130.57) and female sex (HR: 0.94; 95%CI: 0.90\u20130.98) were associated with lower access to first KT. KT candidates between 15 and 19 years had lower access to first and second KT (aHR: 0.69; 95%CI: 0.66\u20130.73, and aHR: 0.70; 95%CI: 0.61\u20130.81) compared to 10\u201314 year-olds. Compared to CAKUT, glomerulonephritis patients had lower access to KT (aHR: 0.75; 95%CI: 0.71\u20130.80 for first, aHR: 0.89; 95%CI: 0.81\u20130.98 for second, and aHR: 0.80; 95%CI: 0.66\u20130.97 for third KT). Similarly, patients with primary renal diseases with high risk of recurrence, had lower chances of receiving a first and second KT (aHR: 0.80; 95%CI: 0.76\u20130.85 for first, aHR: 0.86; 95%CI: 0.78\u20130.95 for second KT). Access to re-transplantation was also higher with previous pre-emptive KT and previous graft survival exceeding 5 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our study highlights KT access disparities particularly for females, the youngest recipients, high-risk age (15\u201319 years), and diseases with recurrence risk. Notably, pre-emptive transplants and enduring previous grafts offer advantages regarding re-transplantation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ndt\/gfaf025","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T20:38:36Z","timestamp":1739392716000},"page":"1580-1589","source":"Crossref","is-referenced-by-count":2,"title":["Access to kidney transplantation and re-transplantation from childhood to adulthood: long-term data from the ERA Registry"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7130-0439","authenticated-orcid":false,"given":"Evgenia","family":"Preka","sequence":"first","affiliation":[{"name":"Department of Paediatric Nephrology, H\u00f4pital Universitaire Necker-Enfants Malades, Assistance Publique \u2013 H\u00f4pitaux de Paris (APHP), INSERM U1163, Universit\u00e9 de Paris Cit\u00e9 , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1719-940X","authenticated-orcid":false,"given":"Marjolein","family":"Bonthuis","sequence":"additional","affiliation":[{"name":"ESPN\/ERA Registry, Amsterdam UMC, location University of Amsterdam, Department of Medical Informatics , Amsterdam ,","place":["the Netherlands"]},{"name":"ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics , Amsterdam ,","place":["Netherlands"]},{"name":"Amsterdam Public Health Research Institute, Quality of Care , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen D","family":"Marks","sequence":"additional","affiliation":[{"name":"Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust , London ,","place":["UK"]},{"name":"NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7560-2669","authenticated-orcid":false,"given":"Anneke","family":"Kramer","sequence":"additional","affiliation":[{"name":"ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics , Amsterdam ,","place":["Netherlands"]},{"name":"Amsterdam Public Health Research Institute, Quality of Care , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9284-3595","authenticated-orcid":false,"given":"Aiko P J","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Leiden University Medical Center , Leiden , , , Leiden ,","place":["The Netherlands The Netherlands"]},{"name":"Leiden Transplant Center, Leiden University Medical Center , Leiden , , , Leiden ,","place":["The Netherlands The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren S","family":"S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Rigshospitalet, Copenhagen University Hospital , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6530-9672","authenticated-orcid":false,"given":"Sevcan A","family":"Bakkalo\u011flu","sequence":"additional","affiliation":[{"name":"Gazi University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology , Ankara ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Bistrup","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Odense University Hospital , Odense ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1815-7327","authenticated-orcid":false,"given":"Timo","family":"Jahnukainen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology and Transplantation, New Children's Hospital, Helsinki University Hospital , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga L","family":"Rodriguez Ar\u00e9valo","sequence":"additional","affiliation":[{"name":"Registry of Kidney Patients of the Valencian Community, General Directorate of Public Health, Ministry of Health , Valencia ,","place":["Spain"]},{"name":"Health and Well-being Technologies Program, Polytechnic University of Valencia , Valencia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3057-7306","authenticated-orcid":false,"given":"Lukas","family":"Buchwinkler","sequence":"additional","affiliation":[{"name":"Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck , Innsbruck ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-0772","authenticated-orcid":false,"given":"M\u00e5rten","family":"Segelmark","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences in Lund, Lund University and Skane University Hospital , Lund ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4431-3223","authenticated-orcid":false,"given":"J Emilio","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital of Cabuenes , Gij\u00f3n, Asturias ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miha","family":"Arnol","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Medical Centre Ljubljana , Ljubljana ,","place":["Slovenia"]},{"name":"Medical Faculty, University of Ljubljana , Ljubljana ,","place":["Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flor A","family":"Ord\u00f3\u00f1ez-\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Central de Asturias , Oviedo ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"de la Cerda-Ojeda","sequence":"additional","affiliation":[{"name":"Virgen del Rocio Hospital , Seville ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy A","family":"Plumb","sequence":"additional","affiliation":[{"name":"University of Bristol Medical School , Bristol ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shona","family":"Methven","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Aberdeen Royal Infirmary , Scotland ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runolfur","family":"Palsson","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Landspitali-The National University Hospital of Iceland , Reykjavik ,","place":["Iceland"]},{"name":"Faculty of Medicine, School of Health Sciences, University of Iceland , Reykjavik ,","place":["Iceland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torbj\u00f6rn","family":"Lundgren","sequence":"additional","affiliation":[{"name":"Division of Transplantation Surgery, CLINTEC, Karolinska Institute , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9ctor","family":"R\u00edos","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Department, Hospital Universitari Vall d\u00b4Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9805-9523","authenticated-orcid":false,"given":"Alberto","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0007-1947","authenticated-orcid":false,"given":"Vianda S","family":"Stel","sequence":"additional","affiliation":[{"name":"ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics , Amsterdam ,","place":["Netherlands"]},{"name":"Amsterdam Public Health Research Institute, Quality of 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