Paulo Cesar Koch Nogueira1,2, Maria Fernanda Camargo de Carvalho3, Luciana de Santis Feltran3,4, Tulio Konstantyner4, Ricardo Sesso5. 1. Pediatric Renal Transplant Service, Hospital Samaritano de São Paulo, Sao Paulo, Sao Paulo, Brazil. pkoch.dped@epm.br. 2. Pediatrics Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Sao Paulo, Brazil. pkoch.dped@epm.br. 3. Pediatric Renal Transplant Service, Hospital Samaritano de São Paulo, Sao Paulo, Sao Paulo, Brazil. 4. Pediatrics Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Sao Paulo, Brazil. 5. Nephrology Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Sao Paulo, Brazil.
Abstract
BACKGROUND: The aim of this study was to describe the access and factors associated with kidney transplantation for children in different regions of Brazil. METHODS: We analyzed a cohort of 1211 children enrolled on the transplant list from January 2011 to December of 2013. We fitted regression models to investigate factors associated with: (a) undergoing kidney transplantation from a deceased donor, and (b) being removed from the waiting list. RESULTS: The incidence of transplantation was uneven across regions, with the lowest rate at 0.4 per million age-related population (pmarp) in the Midwest and the highest incidence rate of 8.3 cases pmarp in the South. Children from the North and the Midwest regions had a 3-4 times lower probability of undergoing a deceased donor transplant (p < 0.05). Apart from the geographic region, age of recipients and GDP influenced the outcome. The likelihood of undergoing transplantation was very low in the youngest children in the North and Midwest. The number of transplant centers was not associated with either outcome. CONCLUSIONS: Factors of inequality in transplantation in Brazil are of macroeconomic origin, but there is room to reduce inequalities. Training existing transplant center professionals in the care of children could diminish the discrepancies.
BACKGROUND: The aim of this study was to describe the access and factors associated with kidney transplantation for children in different regions of Brazil. METHODS: We analyzed a cohort of 1211 children enrolled on the transplant list from January 2011 to December of 2013. We fitted regression models to investigate factors associated with: (a) undergoing kidney transplantation from a deceased donor, and (b) being removed from the waiting list. RESULTS: The incidence of transplantation was uneven across regions, with the lowest rate at 0.4 per million age-related population (pmarp) in the Midwest and the highest incidence rate of 8.3 cases pmarp in the South. Children from the North and the Midwest regions had a 3-4 times lower probability of undergoing a deceased donor transplant (p < 0.05). Apart from the geographic region, age of recipients and GDP influenced the outcome. The likelihood of undergoing transplantation was very low in the youngest children in the North and Midwest. The number of transplant centers was not associated with either outcome. CONCLUSIONS: Factors of inequality in transplantation in Brazil are of macroeconomic origin, but there is room to reduce inequalities. Training existing transplant center professionals in the care of children could diminish the discrepancies.
Entities:
Keywords:
Demography; Epidemiology; Kidney transplantation; Pediatrics; Supply and distribution
Authors: Marcello Tonelli; Scott Klarenbach; Braden Manns; Bruce Culleton; Brenda Hemmelgarn; Stefania Bertazzon; Natasha Wiebe; John S Gill Journal: CMAJ Date: 2006-08-29 Impact factor: 8.262
Authors: A J Matas; J M Smith; M A Skeans; B Thompson; S K Gustafson; D E Stewart; W S Cherikh; J L Wainright; G Boyle; J J Snyder; A K Israni; B L Kasiske Journal: Am J Transplant Date: 2015-01 Impact factor: 8.086
Authors: David A Axelrod; Krista L Lentine; Huiling Xiao; Thomas Bubolz; David Goodman; Richard Freeman; Janet E Tuttle-Newhall; Mark A Schnitzler Journal: Surgery Date: 2013-12-14 Impact factor: 3.982
Authors: Jeffrey Goldhagen; Radley Remo; Thomas Bryant; Peter Wludyka; Amy Dailey; David Wood; Graham Watts; William Livingood Journal: Pediatrics Date: 2005-11-01 Impact factor: 7.124
Authors: J Harambat; K J van Stralen; F Schaefer; R Grenda; A Jankauskiene; M Kostic; M-A Macher; H Maxwell; Z Puretic; A Raes; J Rubik; S S Sørensen; U Toots; R Topaloglu; B Tönshoff; E Verrina; K J Jager Journal: Am J Transplant Date: 2013-05-29 Impact factor: 8.086
Authors: Sophie Ploos van Amstel; Marlies Noordzij; Bradley A Warady; Francisco Cano; Jonathan C Craig; Jaap W Groothoff; Kenji Ishikura; Alicia Neu; Hesham Safouh; Hong Xu; Kitty J Jager; Franz Schaefer Journal: Pediatr Nephrol Date: 2017-12-22 Impact factor: 3.714
Authors: Mariana A Vasconcelos; Ana Carmen Q Mendonça; Enrico A Colosimo; Noureddin Nourbakhsh; Hercílio Martelli-Júnior; Ludmila R Silva; Maria Christina L Oliveira; Clara C Pinhati; Robert H Mak; Ana Cristina Simões E Silva; Eduardo A Oliveira Journal: Pediatr Nephrol Date: 2022-04-29 Impact factor: 3.651