Objectives: to investigate the incidence trend of transplanted immigrant children and to analyze kidney transplant (KTx) practice and outcome for immigrant compared to native children.
Methods: We performed a retrospective study to analyze the percentage trend of “foreign patients” (FP) (children with one/both parents born in non-Western European countries) aged ≤21 years, transplanted in the period 2002-2021 at our Center and to compare data of FP and “domestic patients” (DP) during the period 2017-2021.
Results: The percentage of FP was 22.3% and 34.6% (p:0.04) in the decades 2002-2011 and 2012-2021 respectively. Baseline and transplantation characteristics of patients in the period 2017-2021 are summarized in Table 1.

Compared to DP, FP receive less pre-emptive and living donor (LD) KTx and spend more time on dialysis before KTx. Moreover, Kaplan-Meier survival analysis was used to assess the 5-year KTx survival (patients censored at acute rejection episodes, ARE) and showed a significant increased risk of ARE in FP compared to DP (8 vs 1 events, p < 0.0001) [Figure 1].

The first ARE occurred after a period of 2.3 months (IQR 3.1-17.4) and 32.4 months in FP and DP patients respectively. We also found a significant difference in HLA mismatch with a higher median value in FP population.
Conclusion: Our study confirms the progressive increase of FP in recent years in Italy. In line with other studies in Europe, we found disparities in practice and outcomes of KTx in FP, that can be attributed to cultural factors and language difficulties, even if immunological and genetic factors, such as different pharmacokinetic profile, should be analyzed. While waiting to better understand the mechanisms behind this phenomenon, it can be useful to build a multidisciplinary network and ad hoc initiatives around FP, in order to support these patients and their family to improve their outcome.