The impact of socioeconomic status and geographic remoteness on access to pre-emptive kidney transplantation and transplant outcomes among children
- 469 Downloads
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.
KeywordsKidney transplantation Pre-emptive living donor transplantation Survival analyses Paediatrics Geographic remoteness Socioeconomic factors
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.
- 11.Axelrod DA, Dzebisashvili N, Schnitzler MA, Salvalaggio PR, Segev DL, Gentry SE, Tuttle-Newhall J, Lentine KL (2010) The interplay of socioeconomic status, distance to center, and interdonor service area travel on kidney transplant access and outcomes. Clin J Am Soc Nephrol 5:2276–2288CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Satayathum S, Pisoni RL, McCullough KP, Merion RM, Wikstrom B, Levin N, Chen K, Wolfe RA, Goodkin DA, Piera L, Asano Y, Kurokawa K, Fukuhara S, Held PJ, Port FK (2005) Kidney transplantation and wait-listing rates from the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int 68:330–337CrossRefPubMedGoogle Scholar
- 21.Tromp WF, Cransberg K, van der Lee JH, Bouts AH, Collard L, Van Damme-Lombaerts R, Godefroid N, Van Hoeck KJ, Koster-Kamphuis L, Lilien MR, Raes A, Ranguelov N, Groothoff JW (2012) Fewer pre-emptive renal transplantations and more rejections in immigrant children compared to native Dutch and Belgian children. Nephrol Dial Transplant 27:2588–2593CrossRefPubMedGoogle Scholar
- 25.Australian Bureau of Statistics (2006) Australian Standard Geographical Classification 2006. Available at: www.abs.gov.au
- 30.Kasiske BL, Snyder JJ, Matas AJ, Ellison MD, Gill JS, Kausz AT (2002) Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol 13:1358–1364Google Scholar
- 37.Joshi S, Gaynor JJ, Bayers S, Guerra G, Eldefrawy A, Chediak Z, Companioni L, Sageshima J, Chen L, Kupin W, Roth D, Mattiazzi A, Burke GW 3rd, Ciancio G (2013) Disparities among blacks, hispanics, and whites in time from starting dialysis to kidney transplant waitlisting. Transplantation 95:309–318CrossRefPubMedGoogle Scholar