9-2. Kidney transplantation in children in Russia. Mikhail Kaabak (eng)
Upcoming SlideShare
Loading in...5
×
 

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

on

  • 359 views

 

Statistics

Views

Total Views
359
Views on SlideShare
356
Embed Views
3

Actions

Likes
0
Downloads
1
Comments
0

1 Embed 3

http://kidney.org.ru 3

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

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

  • Pediatric kidney transplantation in Russia Michael KAABAK Boris Petrovsky Scientific Center of Surgery, RAMS The IPNA/ESPN teaching course “Pediatric Nephrology: Evidence-based statements and open questions“, October 22 – 24, 2013, Moscow, Russia
  • EPIDEMIOLOGY Incidence of ESRD in children according to Russian registry: 18,8 per million of age-related population. It means: ≈ 300 new cases every year
  • EPIDEMIOLOGY USA – number of kidney transplants, OPTN database 2011 2010 2009 2008 2007 2006 <1y 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 total 756 748 866 773 796 893 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
  • Pediatric kidney Тх: 2011 (2012) Shumakov inst urology inst Petrovsky inst RCCH - 6 (6) - 1 (3) - 25 (22) - 38 (25) Volzhsky- 1 (2) Ufa - 1 (1) Saratov - 1 (0) Irkutsk - 1 (0) Omsk - 0 (1) Novosibirsk - 0 (1) 74 (61)
  • Boris Petrovsky Scientific Center of Surgery, RAMS Russian Children Clinical Hospital, Ministry of Public Health ≥80% pediatric kidney Тх in Russia March 01, 1990 – December 31, 2012 823 kidney Tx to children from 0 to 18 years
  • Boris Petrovsky Scientific Center of Surgery, RAMS Russian Children Clinical Hospital, Ministry of Public Health ≥80% pediatric kidney Тх in Russia March 01, 1990 – December 31, 2012 823 kidney Tx to children from 0 to 18 years 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.
  • People living with functioning kidney graft, first kidney Tх in childhood (<18 years), prevalence per million age related population. by region from 0 to 60, average 13,1 and 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)
  • People living with functioning kidney graft, first kidney Tх in childhood (<18 years), prevalence per million age related population. by region from 0 to 60, average 13,1 and 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)
  • People living with functioning kidney graft, first kidney Tх in childhood (<18 years), prevalence per million age related population. by region from 0 to 60, average 13,1 and 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)
  • People living with functioning kidney graft, first kidney Tx in childhood (<18 years), prevalence per million are related population. 14 12 10 8 6 4 2 0 2005 2006 2007 2008 2009 2010 2011 2012
  • People living with functioning kidney graft, first kidney Tx in childhood (<18 years), prevalence per million are related population. 14 12 10 8 6 7.7 4 Moscow 2 0 2005 2006 2007 2008 2009 2010 2011 2012
  • People living with functioning kidney graft, first kidney Tx in childhood (<18 years), prevalence per million are related population. 14 12 12.8 10 8 St Petersburg 6 7.7 4 Moscow 2 0 2005 2006 2007 2008 2009 2010 2011 2012
  • 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
  • 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%.
  • 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%. Moscow 44%, Orel region 50%, Kursk region 66%, Tula region 75%, Novgorod region 100% and Mari EL republic 100%
  • 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%. 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
  • 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%. 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 them, the number of people living with a functioning graft, higher than the average figure for Russia in 17 regions
  • Республика Северная Осетия — Алания Ульяновская область Ленинградская область Тверская область Нижегородская область Забайкальский край Белгородская область Республика Коми Липецкая область Самарская область Челябинская область Ивановская область Воронежская область Ярославская область Алтайский край Архангельская область Республика Татарстан 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
  • 7,7 0 5,3 9,3 4,4 0 = underdeveloped regions (losses> 40% for 8 years (2005-2012), the number of children>100 thousand) = successful regions
  • 92 death 823 transplants, 1990 – 2012 ранний п/о early post-Tx unknown неизвестно рецидив recurrence смерть с функционирующим тр-том death with functioning graft uremia уремия
  • 92 death 823 transplants, 1990 – 2012 ранний п/о early post-Tx unknown неизвестно рецидив recurrence смерть с функционирующим тр-том death with functioning graft uremia уремия ?–8 CMV – 4 sepsis – 3 chickenpox – 1 pneumonia – 8 ascaridiasis – 1 meningitis – 2 anemia – 1 GI bleeding – 1 brain hemorrhage – 1
  • 92 death 823 transplants, 1990 – 2012 ранний п/о early post-Tx unknown неизвестно рецидив recurrence смерть с функционирующим тр-том death with functioning graft uremia уремия ?–8 CMV – 4 sepsis – 3 chickenpox – 1 pneumonia – 8 ascaridiasis – 1 meningitis – 2 anemia – 1 GI bleeding – 1 brain hemorrhage – 1
  • 92 death 823 transplants, 1990 – 2012 ?–8 CMV – 4 sepsis – 3 chickenpox – 1 pneumonia – 8 ascaridiasis – 1 meningitis – 2 anemia – 1 GI bleeding – 1 brain hemorrage – 1 82% of the known causes of death with a functioning graft are infections ранний п/о early post-Tx неизвестно unknown рецидив recurrence смерть functioning graft death with с функционирующим тр-том уремия uremia
  • TUBERCULOSIS
  • TUBERCULOSIS Boris Petrovsky SCS ≈1000 pts are followed after abdominal organ transplantation
  • TUBERCULOSIS Boris Petrovsky SCS ≈1000 pts are followed after abdominal organ transplantation 10 pts received treatment for tuberculosis
  • TUBERCULOSIS Boris Petrovsky SCS ≈1000 pts are followed after abdominal organ transplantation 10 pts received treatment for tuberculosis 2 pts died 2 pts lost grafts
  • TUBERCULOSIS Boris Petrovsky SCS ≈1000 pts are followed after abdominal organ transplantation 10 pts received treatment for tuberculosis 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 1 year 3 years Kaabak et al. Pediatr Transplantation, 2013:17 Graft survival 96 2% 89 4%
  • 101 consecutive LRD kidney Tx 2006-2010. Alemtuzumab 12-21 days before Tx 1 year 3 years Graft survival 96 2% 89 4% Expected half life18-19 years Kaabak et al. Pediatr Transplantation, 2013:17
  • 101 consecutive LRD kidney Tx 2006-2010. Alemtuzumab 12-21 days before Tx 100.0 Actuarial graft survival Graft survival, % 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 years post transplant 180с 1/2 270с 3/4 11год 2года 2 3года 3 Series1 92.5 90.8 89.9 89.1 86.0 82.4 Series2 90.3 89.6 88.9 88.2 84.3 80.4 Series3 94.8 92.0 90.8 89.9 87.7 84.4 1/4 4года 4 55лет 6лет 6 7лет 7 8лет 8 9лет 9 10 лет 11 лет 12 лет 13 13 лет 82.0 80.3 78.4 75.3 72.9 71.7 68.9 68.5 67.6 60.9 Expected half life 18-19 years Kaabak et al. Pediatr Transplantation, 2013:17 10 11 12
  • 101 consecutive LRD kidney Tx 2006-2010. Alemtuzumab 12-21 days before Tx 100.0 Actuarial graft survival Graft survival, % 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 years post transplant 180с 1/2 270с 3/4 11год 2года 2 3года 3 Series1 92.5 90.8 89.9 89.1 86.0 82.4 Series2 90.3 89.6 88.9 88.2 84.3 80.4 Series3 94.8 92.0 90.8 89.9 87.7 84.4 1/4 4года 4 55лет 6лет 6 7лет 7 8лет 8 9лет 9 10 лет 11 лет 12 лет 13 13 лет 82.0 80.3 78.4 75.3 72.9 71.7 68.9 68.5 67.6 60.9 Expected half life 18-19 years Kaabak et al. Pediatr Transplantation, 2013:17 10 11 12
  • 101 consecutive LRD kidney Tx 2006-2010. Alemtuzumab 12-21 days before Tx 100.0 Actuarial graft survival Graft survival, % 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 years post transplant 180с 1/2 270с 3/4 11год 2года 2 3года 3 Series1 92.5 90.8 89.9 89.1 86.0 82.4 Series2 90.3 89.6 88.9 88.2 84.3 80.4 Series3 94.8 92.0 90.8 89.9 87.7 84.4 1/4 4года 4 55лет 6лет 6 7лет 7 8лет 8 9лет 9 10 лет 11 лет 12 лет 13 13 лет 82.0 80.3 78.4 75.3 72.9 71.7 68.9 68.5 67.6 60.9 Expected half life 18-19 years Kaabak et al. Pediatr Transplantation, 2013:17 10 11 12
  • 101 consecutive LRD kidney Tx 2006-2010. Alemtuzumab 12-21 days before Tx 100.0 Actuarial graft survival Graft survival, % 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 years post transplant 180с 1/2 270с 3/4 11год 2года 2 3года 3 Series1 92.5 90.8 89.9 89.1 86.0 82.4 Series2 90.3 89.6 88.9 88.2 84.3 80.4 Series3 94.8 92.0 90.8 89.9 87.7 84.4 1/4 4года 4 55лет 6лет 6 7лет 7 8лет 8 9лет 9 10 лет 11 лет 12 лет 13 13 лет 82.0 80.3 78.4 75.3 72.9 71.7 68.9 68.5 67.6 60.9 Expected half life 18-19 years Kaabak et al. Pediatr Transplantation, 2013:17 10 11 12
  • 62 consecutive LRD kidney Tx 2008-2010. Alemtuzumab 12-21 days before Tx 1 year 3 year Graft survival 97 3% 92 6%
  • 62 consecutive LRD kidney Tx 2008-2010. Alemtuzumab 12-21 days before Tx 1 year 3 year Graft survival 97 3% 92 6% Expected half life 42-43 years