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Background: The aim of this study was to identify trends in total, deceased donor (DD) and living donor (LD) kidney transplantation (KT) rates in European countries., Methods: The European Renal Association (ERA) Registry and the Global Observatory on Donation and Transplantation (GODT) databases were used to obtain the number of KTs in individual European countries between 2010 and 2018. General population counts were obtained from Eurostat or the national bureaus of statistics. The KT rate per million population (p.m.p.) and the average annual percentage change (APC) were calculated., Results: The total KT rate in the 40 participating countries increased with 1.9% annually  [95%  confidence  interval  (CI) 1.5, 2.2] from 29.6 p.m.p. in 2010 to 34.7 p.m.p. in 2018, reflecting an increase of 3.4 p.m.p. in the DD-KT rate (from 21.6 p.m.p. to 25.0 p.m.p.; APC 1.9%; 95% CI 1.3, 2.4) and of 1.5 p.m.p. in the LD-KT rate (from 8.1 p.m.p. to 9.6 p.m.p.; APC 1.6%; 95% CI 1.0, 2.3). The trends in KT rate varied widely across European countries. An East-West gradient was observed for DD-KT rate, with Western European countries performing more KTs. In addition, most countries performed fewer LD-KTs. In 2018, Spain had the highest DD-KT rate (64.6 p.m.p.) and Turkey the highest LD-KT rate (37.0 p.m.p.)., Conclusions: The total KT rate increased due to a rise in the KT rate from DDs and to a lesser extent from LDs, with large differences between individual European countries., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)

Background: Although kidney transplantation (KT) is considered the best treatment for end-stage renal disease (ESRD), there are concerns about its benefit in the obese population because of the increased incidence of post-transplant adverse events. We compared patients who underwent KT versus patients awaiting KT on dialysis., Methods: We estimated the life expectancy [restricted mean survival time (RMST)] for a 10-year follow-up by matching on time-dependent propensity scores. The primary outcome was time to death., Results: In patients with a body mass index (BMI) ≥30 kg/m2 (n = 2155 patients per arm), the RMST was 8.23 years [95% confidence interval (CI) 8.05-8.40] in the KT group versus 8.00 years (95% CI 7.82-8.18) in the awaiting KT group, a difference of 2.71 months (95% CI -0.19-5.63). In patients with a BMI ≥35 kg/m2 (n = 212 patients per arm), we reported no significant difference [8.56 years (95% CI 7.96-9.08) versus 8.66 (95% CI 8.10-9.17)]. Hence we deduced that KT in patients with a BMI between 30 and 35 kg/m2 was beneficial in terms of life expectancy., Conclusion: Regarding the organ shortage, KT may be questionable for those with a BMI ≥35 kg/m2. These results do not mean that a BMI ≥35 kg/m2 should be a barrier to KT, but it should be accounted for in allocation systems to better assign grafts and maximize the overall life expectancy of ESRD patients., (© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.)

Background: This national multicentre retrospective cohort study aimed to assess the long-term outcomes of dual kidney transplantation (DKT) and compare them with those obtained from single kidney transplantation (SKT)., Methods: Our first analysis concerned all first transplants performed between May 2002 and December 2014, from marginal donors, defined as brain death donors older than 65 years, with an estimated glomerular filtration rate (eGFR) lower than 90 mL/min/1.73 m2. The second analysis was restricted to transplants adequately allocated according to the French DKT program based on donor eGFR: DKT for eGFR between 30 and 60, SKT for eGFR between 60 and 90 mL/min/1.73 m2. Recipients younger than 65 years or with a panel-reactive antibody percentage ≥25% were excluded., Results: The first analysis included 461 DKT and 1131 SKT. DKT donors were significantly older (77.6 versus 74 years), had a more frequent history of hypertension and a lower eGFR (55.1 versus 63.6 mL/min/1.73 m2). While primary nonfunction and delayed graft function did not differ between SKT and DKT, 1-year eGFR was lower in SKT recipients (39 versus 49 mL/min/1.73 m2, P < 0.001). Graft survival was significantly better in DKT, even after adjustment for recipient and donor risk factors. Nevertheless, patient survival did not differ between these groups. The second analysis included 293 DKT and 687 SKT adequately allocated with donor eGFR and displayed similar results but with a smaller benefit in terms of graft survival., Conclusions: In a context of organ shortage, DKT is a good option for optimizing the use of kidneys from very expanded criteria donors., (© The Author(s) 2021. Published by Oxford University Press on behalf of the ERA.)

Background: Major inequalities in access to renal transplant waiting lists have been demonstrated among adult patients both in the USA and Europe. In this French nationwide study, we sought to ascertain the influence of patient and centre characteristics., Methods: We included all children (<18 years) in the French End-Stage Renal Disease National Registry, who started renal replacement therapy (RRT) between 1 January 2002 and 31 December 2011. The primary outcome was the probability of being listed within 6 months after starting RRT. Hierarchical logistic regression models were used to study the association between the patient or the centre characteristics and the outcome. Centre effects were assessed by studying the centre-level residual variance., Results: A total of 614 incident patients treated in 54 centres were included; 421 (68.6%) were listed within 6 months after starting RRT. A higher risk of not being listed was found in patients younger than 2 years or with a renal disease with a high risk of recurrence after transplantation [odds ratio (OR): 2.61; 95% confidence interval (CI): 1.37-4.97]. We found a significant vintage effect: the probability of not being listed decreased over time (OR per 1 year +0.83, 95% CI: 0.74-0.94). Although we found no significant gender effect, a trend towards disfavouring girls persisted over the study period. We found a significant centre effect that remained after adjusting for patient characteristics. However, none of the centre characteristics that we studied (centre size, pre-emptive transplantation program, paediatric versus adult centres and the proportion of patients on the waiting list placed on inactive status during the first month after listing) explained this variability., Conclusions: Our study confirms inequalities among children in rapid access to the renal transplant waiting list and shows that patient and centre characteristics play a role in these inequalities. Further studies focusing on the organization and practices of the centres are needed to explain the remaining variability., (© The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)