Median of donor age (years) Supplementary data
A
20 15 10 5 0
Year of transplantation PKT nPKT
B
35 30 25 20 15 10 5 0
Year of transplantation
PKT nPKT
C
4,5 3,5 4 2,5 3 1,5 2 0,5 1 0
Year of transplantation PKT nPKT
D
80 60 40 20 0
Year of transplantation PKT nPKT
E
600 500 400 300 200 100 0
Year of transplantation
Figure S1. Evolution over the period 1993-2012 of: (A) Median of recipient age (years), (B) Median of donor age (years), (C) Median number of HLA mismatches, (D) Proportion of living donors, and (E) Median of dialysis duration before transplant (days). Over the period 1993-2012, recipient and donor age and number of HLA mismatches remained stable and were roughly similar between PKT and non-PKT patients (panels A, B and C). The proportion of living donors was higher in PKT patients and tended to increase in this group since 2005. No living donor KT was performed in the period 1993-1995 (panel D). The mean dialysis duration before transplant tended to remain stable over the whole study period (panel E). KT, kidney transplantation; nPKT, nonpreemptive kidney transplantation; PKT, preemptive kidney transplantation.
Median of recipient age (years) 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Proportion of living donors (%) 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20121993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Median dialysis duration before transplant (days) 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Median number of HLA mismatches 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Proportion of patients (%) Proportion of patients (%)
A
60 50 40 30 20 10
0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Year of transplantation
PKT nPKT
B
40 35 30 25 20 15 10 5
0 2004 2005 2006 2007 2008 2009 2010 2011 2012 Year of transplantation
PKT nPKT
Figure S2. A, Evolution of the proportion of patients in the 5th quintile of EDI over the period 2002-2012. B, Evolution of the proportion of sensitized patients over the period 2004-2012. The proportion of most deprived patients was higher in non-PKT patients in the period 2002-2012 but remained stable over time in the 2 groups (panel A). The proportion of sensitized patients increased since 2007-2008 in the PKT and non-PKT patients (panel B). EDI, European Deprivation Index; nPKT, nonpreemptive kidney transplantation; PKT, preemptive kidney transplantation.
Figure S3. Probability of surviving without return to dialysis or retransplant after KT (with 95% CI) according to the kidney replacement therapy modality before transplant (preemptive kidney transplantation, peritoneal dialysis or hemodialysis) (Kaplan-Meier estimator and P-value of the log-rank test for testing the crude association). KT, kidney transplantation.
Table S1. Causes of early graft failure (in the 3 months posttransplantation) according to the type of transplantation (PKT or non-PKT).
Causes of graft loss Total (N =93)
PKT, n (%) (N =17)
Non-PKT, n (%) (N =76) Undetermined causes
Primary failure of the transplant Infection
Nonadherence Disease recurrence Acute rejection Chronic rejection
Death with a functioning graft Nonavailable data
3 1 (5.9) 2 (2.8)
67 14 (82.4) 53 (73.6)
0 0 (0.0) 0
0 0 (0.0) 0
2 0 (0.0) 2 (2.8)
3 0 (0.0) 3 (4.2)
7 0 (0.0) 7 (9.7)
7 2 (11.8) 5 (6.9)
4 0 4
PKT, preemptive kidney transplantation.
Table S2. Causes of late graft failure (after 3 months posttransplantation) according to the type of transplantation (PKT or non-PKT).
Causes of graft loss Total (N =479)
PKT, n (%) (N =33)
Non-PKT, n (%) (N =446) Undetermined causes
Vascular complications of the transplant Urological complications of the transplant Primary failure of the transplant
Infection Nonadherence Disease recurrence Acute rejection Chronic rejection
Death with a functioning graft Nonavailable data
45 2 (6.5) 43 (10.1)
3 0 (0.0) 3 (0.7)
2 0 (0.0) 2 (0.5)
5 0 (0.0) 5 (1.2)
9 2 (6.5) 7 (1.6)
20 1 (3.2) 19 (4.5)
38 2 (6.5) 36 (8.5)
47 2 (6.5) 45 (10.6)
263 18 (58.1) 245 (57.6)
24 4 (12.9) 20 (4.7)
23 2 21
PKT, preemptive kidney transplantation.
Table S3. Association between PKT and hazard of graft failure in pediatric kidney transplant recipients. Results of Cox proportional hazard model with all covariables included in the model(N = 1789, number of events = 522).
Variable HR 95% CI P
Type of transplantation < 0.0001
Non-PKT 1
PKT 0.45 0.33–0.62
Recipient age, per year 1.03 1.01–1.05 0.006
Recipient sex 0.74
Female 1
Male 0.97 0.81–1.16
Primary kidney disease 0.72
Other or unknown 1
GD 1.13 0.86–1.49
Hereditary 0.95 0.69–1.30
Vascular 0.99 0.65–1.52
CAKUT 1.03 0.78–1.36
Donor age, per year 1.00 0.99–1.01 0.70
Donor type 0.39
Deceased 1
Living 0.82 0.52–1.29
Cold ischemia time, per hour 1.00 0.99–1.01 0.29 HLA mismatches, per mismatch 1.02 0.94–1.11 0.57
Year of transplantation 0.27
1993 1
1994 1.07 0.69–1.64
1995 1.20 0.78–1.84
1996 0.71 0.45–1.12
1997 1.17 0.74–1.86
1998 1.37 0.88–2.13
1999 1.01 0.62–1.65
2000 1.09 0.68–1.74
2001 1.31 0.81–2.11
2002 1.03 0.61–1.74
2003 1.49 0.90–2.48
2004 0.94 0.53–1.69
2005 1.31 0.76–2.28
2006 1.41 0.80–2.49
2007 0.96 0.48–1.93
2008 0.90 0.43–1.85
2009 1.66 0.88–3.12
2010 0.60 0.21–1.72
2011 1.30 0.56–3.01
2012 1.96 0.75–5.15
HR of all adjustment factors should be interpreted with caution since they might not be adjusted for appropriate confounders (the set of adjusting factors have been selected for estimating the effect of PKT, but not for estimating the effect of these adjustment factors).
CAKUT, congenital anomalies of the kidney and urinary tract; GD, glomerular disease; HR, hazard ratio; PKT, preemptive kidney transplantation.
Table S4. Association between pretransplant dialysis duration and hazard of graft failure in pediatric kidney transplant recipients. Results of Cox proportional hazard model with all covariables included in the model (N = 1740, number of events = 484).
Variable HR 95% CI P
Pretransplant dialysis duration < 0.0001
0 (PKT) 1
0–6 months 1.57 1.08–2.29
6 months–12 months 2.23 1.56–3.19
12 months–24 months 1.99 1.40–2.83
> 24 months 2.26 1.57–3.25
Recipient age, per year 1.03 1.01–1.05 0.02
Recipient sex 0.88
Female 1
Male 0.99 0.82–1.19
Primary kidney disease 0.57
Other or unknown 1
GD 1.15 0.87–1.53
Hereditary 0.92 0.66–1.29
Vascular 0.98 0.63–1.52
CAKUT 1.01 0.75–1.35
Donor age, per year 1.00 0.99–1.01 0.85
Donor type 0.35
Deceased 1
Living 0.79 0.48–1.30
Cold ischemia time, per hour 1.00 0.99–1.01 0.31 HLA mismatches, per mismatch 1.04 0.95–1.13 0.43
Year of transplantation 0.34
1993 1
1994 0.99 0.64–1.53
1995 1.16 0.76–1.79
1996 0.65 0.41–1.03
1997 1.00 0.62–1.61
1998 1.23 0.78–1.93
1999 0.88 0.54–1.45
2000 0.93 0.57–1.50
2001 1.08 0.66–1.77
2002 0.87 0.50–1.49
2003 1.27 0.76–2.13
2004 0.72 0.39–1.33
2005 0.96 0.53–1.72
2006 1.04 0.57–1.90
2007 0.75 0.37–1.55
2008 0.75 0.36–1.55
2009 1.21 0.62–2.34
2010 0.38 0.11–1.24
2011 1.08 0.47–2.50
2012 1.34 0.46–3.86
HR of all adjustment factors should be interpreted with caution since they might not be adjusted for appropriate confounders (the set of adjusting factors have been selected for estimating the effect of PKT, but not for estimating the effect of these adjustment factors).
CAKUT, congenital anomalies of the kidney and urinary tract; GD, glomerular disease; HR, hazard ratio; PKT, preemptive kidney transplantation.
Table S5. Association between kidney replacement therapy modality and hazard of graft failure in pediatric kidney transplant recipients. Results of Cox proportional hazard model with all covariables included in the model(N = 1646, number of events = 436).
Variable HR 95% CI P
According to the kidney replacement therapy modality
< 0.0001
PKT 1
Peritoneal dialysis 1.97 1.34–2.91
Hemodialysis 1.98 1.43–2.75
Recipient age, per year 1.03 1.43–2.75 0.02
Recipient sex 0.95
Female 1
Male 1.01 0.83–1.22
Primary kidney disease 0.40
Other or unknown 1
GD 1.15 0.85–1.55
Hereditary 0.87 0.61–1.24
Vascular 0.97 0.61–1.54
CAKUT 0.95 0.70–1.29
Donor age, per year 1.00 0.99–1.01 0.71
Donor type 0.34
Deceased 1
Living 0.78 0.47–1.30
Cold ischemia time, per hour 1.00 0.99–1.01 0.27 HLA mismatches, per mismatch 1.04 0.94–1.14 0.44
Year of transplantation 0.58
1993 1
1994 1.22 0.75–1.99
1995 1.31 0.81–2.12
1996 0.83 0.49–1.40
1997 1.09 0.63–1.88
1998 1.55 0.93–2.57
1999 1.08 0.62–1.86
2000 1.12 0.66–1.89
2001 1.11 0.63–1.95
2002 0.94 0.52–1.70
2003 1.43 0.81–2.52
2004 0.84 0.44–1.62
2005 1.14 0.61–2.12
2006 1.26 0.67–2.39
2007 0.90 0.42–1.92
2008 0.91 0.43–1.95
2009 1.46 0.73–2.94
2010 0.48 0.14–1.64
2011 1.32 0.55–3.16
2012 1.58 0.53–4.69
HR of all adjustment factors should be interpreted with caution since they might not be adjusted for appropriate confounders (the set of adjusting factors have been selected for estimating the effect of PKT, but not for estimating the effect of these adjustment factors).
CAKUT, congenital anomalies of the kidney and urinary tract; GD, glomerular disease; HR, hazard ratio; PKT, preemptive kidney transplantation.
