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Progress made toward equitable transplantation in children and young adults with kidney disease

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Abstract

Racial disparities in pediatric kidney transplantation have been well described over the last two decades and include disparities in preemptive transplantation, waitlisting, time from activation to transplantation, living donation, and graft outcomes. Changes to the organ allocation system including the institution of Share 35 in 2005 and the Kidney Allocation System (KAS) of 2014 have resulted in resolution of some, but not all racial-ethnic disparities. Despite overall improvements in time from waitlist activation to transplant, disparities remain in preemptive transplantation, time to waitlisting, and living donor transplantation. Although improving under the KAS, racial disparities remain in graft survival as well. Racial disparity in kidney transplant access and graft survival is an international problem within pediatric nephrology. Although the racial group affected may differ, various minoritized pediatric groups across the world are affected by transplant disparities. Social determinants of health including financial access, language barriers, and the presence of a healthy living donor play a role in mediating these disparities. Further investigation is needed to better understand and intervene upon modifiable social, biological, and cultural factors driving the remaining disparity in transplant outcomes.

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Funding

The work in this manuscript has been performed with the support of the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) of the National Institute of Health (NIH) research grant K23-DK123378 (ML).

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  1. Division of Nephrology, Department of Pediatrics, School of Medicine, Indiana University, 699 Riley Hospital Drive, Rm 230, Indianapolis, IN, 46202, USA

    Mercedes Harford & Marciana Laster

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  1. Mercedes Harford
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Correspondence to Marciana Laster.

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This review is part of a Festschrift for Dr. Richard Fine.

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Harford, M., Laster, M. Progress made toward equitable transplantation in children and young adults with kidney disease. Pediatr Nephrol (2024). https://doi.org/10.1007/s00467-024-06309-5

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