Living kidney donors for pediatric transplantation have quadrupled, with many young patients receiving organs from parents or other relatives
February 28, 2008 – More young people in Canada diagnosed with kidney failure are surviving, and one key explanation is an increase in the use of kidney transplantation in young patients. This finding comes from the Canadian Institute for Health Information�s (CIHI) Treatment of End-Stage Organ Failure in Canada, 1996 to 2005,(2007 Annual Report),a new report that includes, for the first time, a special chapter focusing on pediatric patients�those aged 19 and under�diagnosed with end-stage renal disease (ESRD).
While the number of young Canadians newly diagnosed with ESRD remained fairly stable each year from 1981 to 2005 (low of 66, high of 103), survival rates have improved considerably since 1981 primarily due to more kidney transplantation in young patients. The number of young people living with ESRD increased by 169% between 1981 and 2005 (550).
�A diagnosis of kidney failure in early life can have far-reaching, life-long consequences,� says Margaret Keresteci, Manager of Clinical Registries at CIHI. �The good news is that children with kidney failure are living longer, now that transplantation has become the treatment of choice for these patients.�
The vast majority of young patients with kidney failure are living with a kidney transplant, with the number increasing from just over 44% in 1981 to 77% in 2005. Conversely, over this period, the proportion of children treated with dialysis decreased from 56% in 1981 to 22% in 2005. For those treated in the decade between 1991 and 2000, five-year survival rates for young ESRD patients living with a kidney transplant were considerably higher (96%) than for those on dialysis (84%).
�We consider the increase in transplantation, and the corresponding decline in dialysis treatment, a step in the right direction for the quality of life for young kidney patients,� says Dr. M. Clermont, pediatric nephrologist at Montreal’s St-Justine Hospital. �Kidney failure itself, coupled with dialysis treatment, can be devastating to children with ESRD and their families, in terms of physical development, quality and longevity of life.�
Children more likely to be living with a kidney transplant than adult end-stage renal disease patients
In 2005, the proportion of pediatric ESRD patients living with a transplant (77%) was considerably higher than for those patients aged 20 and over (39%). Young kidney failure patients were also much more likely to be treated with a pre-emptive transplant (23%) than their adult counterparts (3%). Pre-emptive transplants are those received by patients who never begin treatment by dialysis.
Parents, siblings donate organs to young patients
The number of kidneys donated to young Canadians by a living donor quadrupled over the 25-year study period and the majority of these organs (90%) come from a parent (78%) or sibling (12%). �We know that young patients with chronic kidney disease who receive a kidney transplant do better than those on dialysis,� says Keresteci. �There can be no better illustration of what the �gift of life� can mean than the positive changes we have seen in the outcomes for young Canadians with ESRD. A transplant will mean a vastly improved quality of life and a better chance for long-term survival.�
Information on the number of children waiting for a transplant is available only for the 10-year period from 1996 to 2005. During that time, the number of patients waiting for kidney transplantation declined to 23 in 2005, compared to 59 in 1996. This consistent reduction differs from the pattern seen in adult ESRD patients, among whom the number waiting for transplants increased from 2,331 in 1996 to 2,920 in 2005. There were no recorded deaths of pediatric patients while waiting for a kidney transplant between 2004 and 2005.
Other report highlights
Additional highlights included in Treatment of End-Stage Organ Failure in Canada, 1996 to 2005:
- The annual number of first-time liver transplants performed on pediatric patients increased by 24% from 1996 to 2005.
- As of December 31, 2005, there were 713 people (of all ages) waiting for a liver transplant in Canada.
- The number of liver transplants performed grew steadily over the 10 years for an overall increase of 241%.
- The number of children under the age of one year receiving donor hearts fluctuated from year to year over the 25-year study period, with the highest number recorded in 2005 (15).
- Between 1996 and 2005, 1,564 patients (of all ages) received a first-time heart transplant and 58 required a subsequent transplant.
- Between 1996 and 2005, a total of 38 people under the age of 18 received a first-time lung transplant.
- The number of adult lung transplants increased by 91% between 1996 and 2005 (from 76 to 145).
- Between 1996 and 2005, there were 553 pancreas transplants recorded in Canada.
- The number of deceased organ donors (of all ages) in Canada changed very little between 1996 (419) and 2005 (414).
- Between 1996 and 2005, there were 4,006 living donors (kidney and liver living donors only). The number of living donors increased from 265 in 1996 to 502 in 2005.
The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada�s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI�s goal: to provide timely, accurate and comparable information. CIHI�s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health. www.cihi.ca.