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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

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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 0.590.670.76 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.

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Abbreviations

KTR:

Kidney transplant recipient

DDKT:

Deceased donor kidney transplant

LDKT:

Living donor kidney transplant

HLA:

Human leukocyte antigen

CKD:

Chronic kidney disease

KRT:

Kidney replacement therapy

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Acknowledgements

The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government. The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the US government.

Funding

This work was supported by grant number KL2TR003099 (Charnaya) from the Johns Hopkins Institute for Clinical and Translational Research (ICTR), K23DK115908-01(Garonzik-Wang) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and K24AI144954 (Segev) from the National Institute of Allergy and Infectious Diseases (NIAID).

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Authors and Affiliations

  1. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Olga Charnaya

  2. Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Laura Zeiser, Dorry L. Segev, Allan Massie & Jacqueline Garonzik-Wang

  3. Medical School for International Health, Ben-Gurion University of the Negev, Be-er Sheva, Israel

    Dolev Yisar

  4. Department of Pediatric Nephrology, University of Manitoba, Winnipeg, Canada

    Aviva Goldberg

  5. Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA

    Dorry L. Segev

  6. Scientific Registry of Transplant Recipients, Minneapolis, MN, USA

    Dorry L. Segev

  7. Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Northwestern University, Chicago, IL, USA

    Priya Verghese

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  1. Olga Charnaya
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Correspondence to Olga Charnaya.

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Charnaya, O., Zeiser, L., Yisar, D. et al. The unfinished journey toward transplant equity: an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014. Pediatr Nephrol 38, 1275–1289 (2023). https://doi.org/10.1007/s00467-022-05676-1

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