TY - JOUR
T1 - The unfinished journey toward transplant equity
T2 - an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014
AU - Charnaya, Olga
AU - Zeiser, Laura
AU - Yisar, Dolev
AU - Goldberg, Aviva
AU - Segev, Dorry L.
AU - Massie, Allan
AU - Garonzik-Wang, Jacqueline
AU - Verghese, Priya
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to International Pediatric Nephrology Association.
PY - 2023/4
Y1 - 2023/4
N2 - 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 1.001.432.06p = 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. Graphical abstract: A higher resolution version of the Graphical abstract is available as Supplementary information [Figure not available: see fulltext.]
AB - 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 1.001.432.06p = 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. Graphical abstract: A higher resolution version of the Graphical abstract is available as Supplementary information [Figure not available: see fulltext.]
KW - Kidney transplant
KW - Pediatric
KW - Racial disparities
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UR - http://www.scopus.com/inward/citedby.url?scp=85133836717&partnerID=8YFLogxK
U2 - 10.1007/s00467-022-05676-1
DO - 10.1007/s00467-022-05676-1
M3 - Article
C2 - 35816202
AN - SCOPUS:85133836717
SN - 0931-041X
VL - 38
SP - 1275
EP - 1289
JO - Pediatric Nephrology
JF - Pediatric Nephrology
IS - 4
ER -