6858 GRAFT SURVIVAL IN MULTIPLE KIDNEY TRANSPLANT RECIPIENTS FROM CHILDHOOD TO ADULTHOOD: AN ERA STUDY FROM 1978 UNTIL 2019

Abstract Background and Aims Knowledge regarding graft survival after transplantation in European children with multiple kidney transplants followed from childhood into adulthood including factors affecting these outcomes is lacking. Method Using ERA Registry data, we investigated all patients on kidney replacement therapy (KRT) who received their first kidney transplant (KT) before 20 years of age between 1978 and 2019. Graft survival after first, second and third KT were studied alongside their risk factors, using Kaplan-Meier survival analysis and multivariable Cox regression models. Results Among 10012 paediatric KT candidates, 8601, 1962 and 412 received at least one, two and three KTs. Graft survival at 5 and 10 years was 80.6% and 65.7% for first KTs, 71.3% and 53.7% for second KTs and 67.1 and 49.5% for third KTs. Factors associated with increased graft failure risk were having glomerulonephritis or a recurrent disease as cause of kidney failure for first KT recipients (aHR 1.24, 95%CI 1.12-1.37 and aHR 1.24, 95%CI 1.13-1.37, respectively). Patients whose first KT lifespan was between 0–30 days or more than 5 years presented lower graft failure risks regarding their second KT compared to patients whose KT survived between 1–5 years (aHR 0.79, 95%CI 0.64-0.98 and aHR 0.73, 95%CI 0.61-0.88, respectively). Similar results were found for third KT recipients whose second KT lived for more than 5 years (aHR 0.61, 95%CI 0.41-0.92). Patients who were transplanted for the first and second time before 2007 presented a higher graft failure risk compared to patients who received their KT between 2016–2019 (aHR 2.09, 95%CI 1.65-2.65 and aHR 1.63 95%CI 1.29-2.06 for the transplantation era before 2000 and between 2000–2007 concerning the first KT; and aHR 1.69, 95%CI 1.15-2.47 and aHR 1.51, 95%CI 1.06-2.16, respectively for the era before 2000 and between 2000–2007 concerning the second KT). Pre-emptive KTs presented less graft failure compared to patients who received dialysis > 1 year for first and second KT (aHR 0.89, 95%CI 0.81-0.98 and aHR 0.63, 95%CI 0.51-0.78,respectively). Patients having received a LD KT had less chances for graft failure for first and second KT (aHR 0.77, 95%CI 0.7-0.84 and aHR 0.71 (0.6-0.85, respectively). Having a second LD KT (no matter the donor type for first KT) was advantageous compared to having a second DD. Conclusion Graft outcomes after pediatric kidney (re)transplantation have improved significantly over time for all recip