9-2. Kidney transplantation in children in Russia. Mikhail Kaabak (eng)

The IPNA/ESPN teaching course “Pediatric Nephrology: Evidence-based statements and open questions“,

October 22 – 24, 2013, Moscow, Russia

Pediatric kidney transplantation in Russia

Michael KAABAK

Boris Petrovsky Scientific Center of Surgery, RAMS

Incidence of ESRD in children according to Russian registry: 18,8 per million of age-related population. It means:

≈ 300new cases every year

EPIDEMIOLOGY

USA – number of kidney transplants, OPTN database

2011 2010 2009 2008 2007 2006

< 1 y 0 1 4 1 2 7

1-5 y 173 158 179 137 162 164

6-10 y 129 144 156 149 141 137

11 -17 y 454 445 527 486 491 585

748total 866 773 796 893756

Population of the United States twice as much of the Russian population, children in US accounted for 20%, in Russia-15%, the expected number of

pediatric kidney transplants in Russia ≈ 300 per year

EPIDEMIOLOGY

Saratov - 1 (0)

Volzhsky- 1 (2)

Shumakov inst - 6 (6)urology inst - 1 (3)Petrovsky inst - 25 (22)RCCH - 38 (25)

Ufa - 1 (1) Irkutsk - 1 (0)

74 (61)Omsk - 0 (1) Novosibirsk - 0 (1)

Pediatric kidney Тх: 2011 (2012)

Boris Petrovsky Scientific Center of Surgery, RAMSRussian Children Clinical Hospital, Ministry of Public Health

March 01, 1990 – December 31, 2012823 kidney Tx to children from 0 to 18 years

≥80% pediatric kidney Тх in Russia

Boris Petrovsky Scientific Center of Surgery, RAMSRussian Children Clinical Hospital, Ministry of Public Health

March 01, 1990 – December 31, 2012823 kidney Tx to children from 0 to 18 years

≥80% pediatric kidney Тх in Russia

Pediatric pharmacology, volume 10, #5, in press

People living with functioning kidney graft, first kidney Tх

in childhood (<18 years), prevalence per million age related

population.



population.

by region from 0 to 60, average 13,1and 9,8 as on December 31, 2010

ESPN/ERA-EDTA registry:in Europe from 0 (Estonia and Albania) to 71 (Finland),average 19,2 as on December 31, 2010 (in Russia 5,7)



population.

by region from 0 to 60, average 13,1and 9,8 as on December 31, 2010

ESPN/ERA-EDTA registry:in Europe from 0 (Estonia and Albania) to 71 (Finland),average 19,2 on December 31, 2010 (in Russia 5,7)



population.

by region from 0 to 60, average 13,1and 9,8 on December 31, 2010

ESPN/ERA-EDTA registry:in Europe from 0 (Estonia and Albania) to 71 (Finland),average 19,2 on December 31, 2010 (in Russia 5,7)

2005 2006 2007 2008 2009 2010 2011 20120

2

4

6

8

10

12

14

People living with functioning kidney graft, first kidney Tx in childhood (<18 years), prevalence per million are

related population.

2005 2006 2007 2008 2009 2010 2011 20120

2

4

6

8

10

12

14

7.7

Moscow


related population.

2005 2006 2007 2008 2009 2010 2011 20120

2

4

6

8

10

12

14

7.7

Moscow

12.8

St Petersburg


related population.

Losses from 2005 to 2012 год – ESRD recurrence or death,

As a percentage of those discharged during this period from transplant center with functioning graft



0 to 100% by region, average 17,7%.



0 to 100% by region, average 17,7%. Moscow 44%, Orel region 50%, Kursk region 66%, Tula region

75%, Novgorod region 100% and Mari EL republic 100%





Among regions with more than 100 000 children, lose less than 10% during 8 years 32 regions





Among regions with more than 100 000 children, lose less than 10% during 8 years 32 regions

Among them, the number of people living with a functioning graft, higher than the average figure for Russia in 17 regions

Республика ТатарстанАрхангельская область

Алтайский крайЯрославская область

Воронежская областьИвановская область

Челябинская областьСамарская областьЛипецкая областьРеспублика Коми

Белгородская областьЗабайкальский край

Нижегородская областьТверская область

Ленинградская областьУльяновская область

Республика Северная Осетия — Алания

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0

= underdeveloped regions (losses> 40% for 8 years (2005-2012), the number of children>100 thousand)

= successful regions

4,49,35,3

0

7,7

0

= underdeveloped regions (losses> 40% for 8 years (2005-2012), the number of children>100 thousand)

= successful regions

ранний п/онеизвестнорецидивсмерть с функционирующим тр-томуремия

92 death823 transplants, 1990 – 2012

early post-Txunknown

recurrencedeath with functioning graft uremia





? – 8CMV – 4sepsis – 3chickenpox – 1pneumonia – 8ascaridiasis – 1meningitis – 2anemia – 1GI bleeding – 1brain hemorrhage – 1





? – 8CMV – 4sepsis – 3chickenpox – 1pneumonia – 8ascaridiasis – 1meningitis – 2anemia – 1GI bleeding – 1brain hemorrhage – 1

CMV – 4sepsis – 3chickenpox – 1pneumonia – 8ascaridiasis – 1meningitis – 2




recurrencerecurrencedeath with functioning graft uremia

? – 8CMV – 4sepsis – 3chickenpox – 1pneumonia – 8ascaridiasis – 1meningitis – 2anemia – 1GI bleeding – 1

brain hemorrage – 1

82% of the known causes of death with a

functioning graft are infections

TUBERCULOSIS

TUBERCULOSISBoris Petrovsky SCS

≈1000 pts are followed after abdominal organ transplantation



10 pts received treatment for tuberculosis




2 pts died 2 pts lost grafts




2 pts died 2 pts lost grafts

The anti-tuberculosis vaccine (BCG) can be injected only before transplantation

Kaabak et al. Pediatr Transplantation, 2013:17

101 consecutive LRD kidney Tx 2006-2010. Alemtuzumab 12-21 days before Tx

Graft survival1 year 96±2%3 years 89±4%



Graft survival1 year 96±2%3 years 89±4%

Expected half life18-19 years


180с 270с 1год 2года 3года 4года 5лет 6лет 7лет 8лет 9лет 10 лет 11 лет 12 лет 13 лет

Series1 92.5233644859813

90.8204804770368

89.854305152813

89.0626372660042

86.005567336965

82.3842802911982

NaN NaN NaN NaN NaN NaN NaN NaN NaN NaN

Series2 90.2946317430531

89.6291434058081

88.9267905346618

88.2030132412888

84.2985584940951

80.3650243954887


Series3 94.7520972289095

92.0118175482656

90.7818197709642

89.9222612907195

87.7125761798351

84.4035361869076

82.0398685677086

80.3226466914533

78.3693616221752

75.2611809803035

72.8844212681704

71.6584083110596

68.9148350834518

68.5307508538131

67.5642810653946

60.9232105722675

5.0

15.0

25.0

35.0

45.0

55.0

65.0

75.0

85.0

95.0 Actuarial graft survival

years post transplant

Gra

ft s

urv

ival

, %

Expected half life 18-19 years


1/4 1/2 3/4 1 2 3 4 5 6 7 8 9 10 11 12 13



Series1 92.5233644859813

90.8204804770368

89.854305152813

89.0626372660042

86.005567336965

82.3842802911982


Series2 90.2946317430531

89.6291434058081

88.9267905346618

88.2030132412888

84.2985584940951

80.3650243954887


Series3 94.7520972289095

92.0118175482656

90.7818197709642

89.9222612907195

87.7125761798351

84.4035361869076

82.0398685677086

80.3226466914533

78.3693616221752

75.2611809803035

72.8844212681704

71.6584083110596

68.9148350834518

68.5307508538131

67.5642810653946

60.9232105722675

5.0

15.0

25.0

35.0

45.0

55.0

65.0

75.0

85.0



Gra

ft s

urv

ival

, %



1/4 1/2 3/4 1 2 3 4 5 6 7 8 9 10 11 12 13



Series1 92.5233644859813

90.8204804770367

89.854305152813

89.0626372660042

86.005567336965

82.3842802911982


Series2 90.2946317430531

89.6291434058081

88.9267905346618

88.2030132412888

84.2985584940951

80.3650243954887


Series3 94.7520972289095

92.0118175482656

90.7818197709642

89.9222612907195

87.7125761798351

84.4035361869076

82.0398685677086

80.3226466914533

78.3693616221752

75.2611809803035

72.8844212681704

71.6584083110596

68.9148350834518

68.5307508538131

67.5642810653946

60.9232105722675

5.0

15.0

25.0

35.0

45.0

55.0

65.0

75.0

85.0



Gra

ft s

urv

ival

, %



1/4 1/2 3/4 1 2 3 4 5 6 7 8 9 10 11 12 13



Series1 92.5233644859813

90.8204804770368

89.854305152813

89.0626372660042

86.005567336965

82.3842802911982


Series2 90.2946317430531

89.6291434058081

88.9267905346618

88.2030132412888

84.2985584940951

80.3650243954887


Series3 94.7520972289095

92.0118175482656

90.7818197709642

89.9222612907195

87.7125761798351

84.4035361869076

82.0398685677086

80.3226466914533

78.3693616221752

75.2611809803035

72.8844212681704

71.6584083110596

68.9148350834518

68.5307508538131

67.5642810653946

60.9232105722675

5.0

15.0

25.0

35.0

45.0

55.0

65.0

75.0

85.0



Gra

ft s

urv

ival

, %



1/4 1/2 3/4 1 2 3 4 5 6 7 8 9 10 11 12 13



Graft survival1 year 97±3%3 year 92±6%


Graft survival1 year 97±3%3 year 92±6%


Health & Medicine

9-2. Kidney transplantation in children in Russia. Mikhail Kaabak (eng)