Olga Charnaya1, Laura Zeiser2, Dolev Yisar3, Aviva Goldberg4, Dorry L Segev2,5,6, Allan Massie2, Jacqueline Garonzik-Wang2, Priya Verghese7. 1. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. ocharna1@jhmi.edu. 2. Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA. 3. Medical School for International Health, Ben-Gurion University of the Negev, Be-er Sheva, Israel. 4. Department of Pediatric Nephrology, University of Manitoba, Winnipeg, Canada. 5. Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA. 6. Scientific Registry of Transplant Recipients, Minneapolis, MN, USA. 7. Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL, USA.
Abstract
BACKGROUND: Disparities in pediatric kidney transplantation (KT) result in reduced access and worse outcomes for minority children. We assessed the impact of recent systems changes on these disparities. METHODS: This is a retrospective cohort study of pediatric patients utilizing data from the US Renal Data System (n = 7547) and Scientific Registry of Transplant Recipients (n = 6567 waitlisted and n = 6848 transplanted patients). We compared access to transplantation, time to deceased donor kidney transplant (DDKT), and allograft failure (ACGF) in the 5 years preceding implementation of the Kidney Allocation System (KAS) to the 5 years post-KAS implementation 2010-2014 vs. 2015-2019, respectively. RESULTS: Compared to the pre-KAS era, post-KAS candidates were more likely to be pre-emptively listed (26.8% vs. 38.1%, p < 0.001), pre-emptively transplanted (23.8% vs. 28.0%, p < 0.001), and less likely to have private insurance (35.6% vs. 32.3%, p = 0.01), but these were not uniform across racial groups. Compared to white children, Black and Hispanic children had a lower likelihood of transplant listing within 2 years of first dialysis service (aHR 0.590.670.76 and 0.730.820.92, respectively) in the post-KAS era. Time to DDKT was comparable across all racial groups in the post-KAS era. Compared to white children, Black DDKT recipients have more 5-year ACGF (aHR 1.001.432.06 p = 0.05) while there was no difference in 3- or 5-year ACGF among LDKT recipients. CONCLUSIONS: After KAS implementation, there is equity in time to DDKT. Pre-KAS increased hazard of ACGF among Black children has decreased in the post-KAS era; however, persistent disparities exist in time to transplant listing among Black and Hispanic children when compared to white children. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: Disparities in pediatric kidney transplantation (KT) result in reduced access and worse outcomes for minority children. We assessed the impact of recent systems changes on these disparities. METHODS: This is a retrospective cohort study of pediatric patients utilizing data from the US Renal Data System (n = 7547) and Scientific Registry of Transplant Recipients (n = 6567 waitlisted and n = 6848 transplanted patients). We compared access to transplantation, time to deceased donor kidney transplant (DDKT), and allograft failure (ACGF) in the 5 years preceding implementation of the Kidney Allocation System (KAS) to the 5 years post-KAS implementation 2010-2014 vs. 2015-2019, respectively. RESULTS: Compared to the pre-KAS era, post-KAS candidates were more likely to be pre-emptively listed (26.8% vs. 38.1%, p < 0.001), pre-emptively transplanted (23.8% vs. 28.0%, p < 0.001), and less likely to have private insurance (35.6% vs. 32.3%, p = 0.01), but these were not uniform across racial groups. Compared to white children, Black and Hispanic children had a lower likelihood of transplant listing within 2 years of first dialysis service (aHR 0.590.670.76 and 0.730.820.92, respectively) in the post-KAS era. Time to DDKT was comparable across all racial groups in the post-KAS era. Compared to white children, Black DDKT recipients have more 5-year ACGF (aHR 1.001.432.06 p = 0.05) while there was no difference in 3- or 5-year ACGF among LDKT recipients. CONCLUSIONS: After KAS implementation, there is equity in time to DDKT. Pre-KAS increased hazard of ACGF among Black children has decreased in the post-KAS era; however, persistent disparities exist in time to transplant listing among Black and Hispanic children when compared to white children. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Xingyu Zhang; Taylor A Melanson; Laura C Plantinga; Mohua Basu; Stephen O Pastan; Sumit Mohan; David H Howard; Jason M Hockenberry; Michael D Garber; Rachel E Patzer Journal: Am J Transplant Date: 2018-04-18 Impact factor: 8.086
Authors: Brittany A Shelton; Deirdre Sawinski; Christopher Ray; Rhiannon D Reed; Paul A MacLennan; Justin Blackburn; Carlton J Young; Stephen Gray; Megan Yanik; Allan Massie; Dorry L Segev; Jayme E Locke Journal: Am J Transplant Date: 2018-02-07 Impact factor: 8.086