Pediatric kidney transplantation in Russia
Michael KAABAK
Boris Petrovsky Scientific Center of Surgery, RAMS

The IPNA/ESP...
EPIDEMIOLOGY
Incidence of ESRD in children according to Russian registry: 18,8
per million of age-related population. It m...
EPIDEMIOLOGY
USA – number of kidney transplants, OPTN database
2011

2010

2009

2008

2007

2006

<1y

0

1

4

1

2

7

...
Pediatric kidney Тх: 2011 (2012)
Shumakov inst
urology inst
Petrovsky inst
RCCH

- 6 (6)
- 1 (3)
- 25 (22)
- 38 (25)

Volz...
Boris Petrovsky Scientific Center of Surgery, RAMS
Russian Children Clinical Hospital, Ministry of Public Health

≥80% ped...
Boris Petrovsky Scientific Center of Surgery, RAMS
Russian Children Clinical Hospital, Ministry of Public Health

≥80% ped...
People living with functioning kidney graft, first kidney Tх
in childhood (<18 years), prevalence per million age related
...
People living with functioning kidney graft, first kidney Tх
in childhood (<18 years), prevalence per million age related
...
People living with functioning kidney graft, first kidney Tх
in childhood (<18 years), prevalence per million age related
...
People living with functioning kidney graft, first kidney Tх
in childhood (<18 years), prevalence per million age related
...
People living with functioning kidney graft, first kidney Tx
in childhood (<18 years), prevalence per million are
related ...
People living with functioning kidney graft, first kidney Tx
in childhood (<18 years), prevalence per million are
related ...
People living with functioning kidney graft, first kidney Tx
in childhood (<18 years), prevalence per million are
related ...
Losses from 2005 to 2012 год –
ESRD recurrence or death,
As a percentage of those discharged during this period from
trans...
Losses from 2005 to 2012 год –
ESRD recurrence or death,
As a percentage of those discharged during this period from
trans...
Losses from 2005 to 2012 год –
ESRD recurrence or death,
As a percentage of those discharged during this period from
trans...
Losses from 2005 to 2012 год –
ESRD recurrence or death,
As a percentage of those discharged during this period from
trans...
Losses from 2005 to 2012 год –
ESRD recurrence or death,
As a percentage of those discharged during this period from
trans...
Республика Северная Осетия — Алания
Ульяновская область
Ленинградская область
Тверская область
Нижегородская область
Забай...
= 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)
...
92 death
823 transplants, 1990 – 2012

ранний п/о
early post-Tx
unknown
неизвестно
рецидив
recurrence
смерть с функциониру...
92 death
823 transplants, 1990 – 2012

ранний п/о
early post-Tx
unknown
неизвестно
рецидив
recurrence
смерть с функциониру...
92 death
823 transplants, 1990 – 2012

ранний п/о
early post-Tx
unknown
неизвестно
рецидив
recurrence
смерть с функциониру...
92 death
823 transplants, 1990 – 2012
?–8
CMV – 4
sepsis – 3
chickenpox – 1
pneumonia – 8
ascaridiasis – 1
meningitis – 2
...
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
f...
TUBERCULOSIS
Boris Petrovsky SCS
≈1000 pts are followed after abdominal organ transplantation

10 pts received treatment
f...
TUBERCULOSIS
Boris Petrovsky SCS
≈1000 pts are followed after abdominal organ transplantation

10 pts received treatment
f...
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 Transplan...
101 consecutive LRD kidney Tx 2006-2010.
Alemtuzumab 12-21 days before Tx

1 year
3 years

Graft survival
96 2%
89 4%

Exp...
101 consecutive LRD kidney Tx 2006-2010.
Alemtuzumab 12-21 days before Tx
100.0

Actuarial graft survival

Graft survival,...
101 consecutive LRD kidney Tx 2006-2010.
Alemtuzumab 12-21 days before Tx
100.0

Actuarial graft survival

Graft survival,...
101 consecutive LRD kidney Tx 2006-2010.
Alemtuzumab 12-21 days before Tx
100.0

Actuarial graft survival

Graft survival,...
101 consecutive LRD kidney Tx 2006-2010.
Alemtuzumab 12-21 days before Tx
100.0

Actuarial graft survival

Graft survival,...
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%

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

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

  1. 1. 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
  2. 2. 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
  3. 3. 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
  4. 4. 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)
  5. 5. 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
  6. 6. 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
  7. 7. People living with functioning kidney graft, first kidney Tх in childhood (<18 years), prevalence per million age related population.
  8. 8. 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)
  9. 9. 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)
  10. 10. 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)
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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%.
  16. 16. 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%
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. = underdeveloped regions (losses> 40% for 8 years (2005-2012), the number of children>100 thousand) = successful regions
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. TUBERCULOSIS
  27. 27. TUBERCULOSIS Boris Petrovsky SCS ≈1000 pts are followed after abdominal organ transplantation
  28. 28. TUBERCULOSIS Boris Petrovsky SCS ≈1000 pts are followed after abdominal organ transplantation 10 pts received treatment for tuberculosis
  29. 29. 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
  30. 30. 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
  31. 31. Kaabak et al. Pediatr Transplantation, 2013:17
  32. 32. 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%
  33. 33. 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
  34. 34. 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
  35. 35. 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
  36. 36. 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
  37. 37. 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
  38. 38. 62 consecutive LRD kidney Tx 2008-2010. Alemtuzumab 12-21 days before Tx 1 year 3 year Graft survival 97 3% 92 6%
  39. 39. 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

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