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Inequality in pediatric kidney transplantation in Brazil

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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.

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Acknowledgments

We acknowledge Professor Cristine Campos de Xavier Pinto for her support with the statistical analysis of the data.

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Authors and Affiliations

  1. Pediatric Renal Transplant Service, Hospital Samaritano de São Paulo, Sao Paulo, Sao Paulo, Brazil

    Paulo Cesar Koch Nogueira, Maria Fernanda Camargo de Carvalho & Luciana de Santis Feltran

  2. Pediatrics Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Sao Paulo, Brazil

    Paulo Cesar Koch Nogueira, Luciana de Santis Feltran & Tulio Konstantyner

  3. Nephrology Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Sao Paulo, Brazil

    Ricardo Sesso

Authors
  1. Paulo Cesar Koch Nogueira
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  2. Maria Fernanda Camargo de Carvalho
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  3. Luciana de Santis Feltran
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  4. Tulio Konstantyner
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  5. Ricardo Sesso
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Corresponding author

Correspondence to Paulo Cesar Koch Nogueira.

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The author(s) declare that they have no competing interests.

Ethical statement

The ethical board of the institution approved the research protocol and formal consent was not required, given the methodology of secondary data analysis utilized.

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Nogueira, P.C.K., de Carvalho, M.F.C., de Santis Feltran, L. et al. Inequality in pediatric kidney transplantation in Brazil. Pediatr Nephrol 31, 501–507 (2016). https://doi.org/10.1007/s00467-015-3226-z

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  • DOI: https://doi.org/10.1007/s00467-015-3226-z

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