Pediatric Nephrology

, Volume 31, Issue 6, pp 1011–1019 | Cite as

The impact of socioeconomic status and geographic remoteness on access to pre-emptive kidney transplantation and transplant outcomes among children

  • Anna Francis
  • Madeleine Didsbury
  • Wai H. Lim
  • Siah Kim
  • Sarah White
  • Jonathan C. Craig
  • Germaine WongEmail author
Original Article



Low socioeconomic status (SES) and geographic disparity have been associated with worse outcomes and poorer access to pre-emptive transplantation in the adult end-stage kidney disease (ESKD) population, but little is known about their impact in children with ESKD. The aim of our study was to determine whether access to pre-emptive transplantation and transplant outcomes differ according to SES and geographic remoteness in Australia.


Using data from the Australia and New Zealand Dialysis and Transplant Registry (1993–2012), we compared access to pre-emptive transplantation, the risk of acute rejection and graft failure, based on SES and geographic remoteness among Australian children with ESKD (≤18 years), using adjusted logistic and Cox proportional hazard modelling.


Of the 768 children who commenced renal replacement therapy, 389 (50.5 %) received living donor kidney transplants and 28.5 % of these (111/389) were pre-emptive. There was no significant association between SES quintiles and access to pre-emptive transplantation, acute rejection or allograft failure. Children residing in regional or remote areas were 35 % less likely to receive a pre-emptive transplant compared to those living in major cities [adjusted odds ratio (OR) 0.65, 95 % confidence interval (CI) 0.45–1.0]. There was no significant association between geographic disparity and acute rejection (adjusted OR 1.03, 95 % CI 0.68–1.57) or graft loss (adjusted hazard ratio 1.05, 95 % CI 0.74–1.41).


In Australia, children from regional or remote regions are much less likely to receive pre-emptive kidney transplantation. Strategies such as improved access to nephrology services through expanding the scope of outreach clinics, and support for regional paediatricians to promote early referral may ameliorate this inequity.


Kidney transplantation Pre-emptive living donor transplantation Survival analyses Paediatrics Geographic remoteness Socioeconomic factors 


Author contributions

AF participated in the writing of the paper and data analysis, MD, SK and JCC participated in the writing of the paper, WHL participated in research design and the writing of the paper, and GW participated in research design, the performance of the research, data analyses and the writing of the paper

Compliance with ethical standards

Due to the retrospective nature of this study neither individual parental consent nor internal review board approval were required

Conflict of interest

The authors declare no conflicts of interest.

Supplementary material

467_2015_3279_MOESM1_ESM.docx (58 kb)
ESM 1 (DOCX 58.5 kb)


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Copyright information

© IPNA 2015

Authors and Affiliations

  • Anna Francis
    • 1
  • Madeleine Didsbury
    • 1
  • Wai H. Lim
    • 2
  • Siah Kim
    • 1
  • Sarah White
    • 1
  • Jonathan C. Craig
    • 1
  • Germaine Wong
    • 1
    Email author
  1. 1.Sydney School of Public HealthUniversity of SydneySydneyAustralia
  2. 2.Sir Charles Gairdner HospitalNedlandsAustralia

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