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11.07.2022 | Original Article

The unfinished journey toward transplant equity: an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014

verfasst von: Olga Charnaya, Laura Zeiser, Dolev Yisar, Aviva Goldberg, Dorry L. Segev, Allan Massie, Jacqueline Garonzik-Wang, Priya Verghese

Erschienen in: Pediatric Nephrology | Ausgabe 4/2023

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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 _0.590.67_0.76 and _0.730.82_0.92, 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 _1.001.43_2.06 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.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

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Titel: The unfinished journey toward transplant equity: an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014
verfasst von: Olga Charnaya
Laura Zeiser
Dolev Yisar
Aviva Goldberg
Dorry L. Segev
Allan Massie
Jacqueline Garonzik-Wang
Priya Verghese
Publikationsdatum: 11.07.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 4/2023
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-022-05676-1

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The unfinished journey toward transplant equity: an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014