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. 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. 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. 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. 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. 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. People living with functioning kidney graft, first kidney Tх
in childhood (<18 years), prevalence per million age related
population.

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

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

22. 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

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

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. 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

26. 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

27. TUBERCULOSIS

28. TUBERCULOSIS
Boris Petrovsky SCS
≈1000 pts are followed after abdominal organ transplantation

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

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

31. 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

32. Kaabak et al. Pediatr Transplantation, 2013:17

33. 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%

34. 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

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. 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. 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. 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

39. 62 consecutive LRD kidney Tx 2008-2010.
Alemtuzumab 12-21 days before Tx
1 year
3 year
Graft survival
97 3%
92 6%

40. 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