Kidney transplantation (KT) is the preferred treatment for end-stage renal disease in children. Compared to dialysis, it confers improved survival, skeletal growth, health-related quality of life, and neuropsychological development.
In Japan, 3.5～4.7 per million children start renal replacement therapy every year. Compared with adults, there is greater use of peritoneal dialysis (PD) or KT as primary therapy. When considering children younger than 5 years of age who began dialysis as their primary mode of renal replacement therapy from 2009 to 2013, we find that 87% were treated with PD, and 22% have received KT preemptively.
The number of pediatric KTs has remained steady at approximately 90 over the past several years. Because of the severe shortage of suitable deceased donor (DD) allograft, most children (85% to 90%) have received kidneys from their living relatives. However, the number of DD KTs has gradually increased since 2002 because the policy was changed for children under the age of 15 to receive priority points.
Graft survival has continued to improve over the past decade. The 5- and 10- year graft survival rate from 1996 to 2009 are 90.1% and 81.1%. Graft survival estimates were 90.1% at 5 years and 81.1% at 10 years for transplants in the same period.
A greater pediatric priority might be associated with a significant decrease in waiting time for DD KTs and a significant increase in the pediatric KT rate.
More action should be extended to increase the total number of DD kidneys. Further, we should increase discussion the new allocation policy concerning kidneys from pediatric donor.