End-stage renal disease (ESRD) in children is a rare but severe disorder with an important impact on physical, psychological and social well-being. Compared to dialysis, kidney transplantation is associated with better patient survival, less comorbidities, and better psychosocial development, and therefore kidney transplantation is considered the optimal treatment.

Previous studies have shown large differences in paediatric kidney transplantation policies and practices between European countries, resulting in disparities in the access to transplantation. Macro-economic factors are known to be associated with these disparities. However, as recent graft failure rates after paediatric kidney transplantation in Europe are not available, it is not known whether these disparities also exist in graft failure rates and which factors could explain potential differences in graft failure rates between European countries. Therefore, we aim to study disparities in graft failure rates between European countries.

Knowledge on disparities in access to and outcome of paediatric kidney transplantation could help to increase awareness amongst health policy makers and the paediatric nephrology community. This knowledge could assist them to explore strategies to reduce these disparities, and eventually lead to better health outcomes in European paediatric ESRD.