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Factors associated with follow-up outside a transplant center among pediatric kidney transplant recipients

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Abstract

Background

Transfer of follow-up care after pediatric kidney transplantation (KTx) may jeopardize quality of care and patient outcomes. We sought to determine if minority status and socioeconomic factors were associated with increased likelihood of follow-up outside a transplant center, and whether this transition of care was associated with worse long-term graft and patient survival.

Methods

We performed an analysis of the United Network for Organ Sharing database, including children age < 18 years who received a kidney transplant between 2003 and 2018. Survival analysis (conditional on survival with functioning graft to 1 year) was performed using a Cox proportional hazards model where transfer of care (place of follow-up recorded as any setting other than a transplant center) was entered as a time-varying covariate.

Results

The study included 10,293, of whom 2083 received care outside of a transplant center during follow-up. Medicare coverage, but not minority race/ethnicity or socioeconomic status, was associated with increased likelihood of follow-up outside a transplant center. Follow-up outside a transplant center was associated with a 10% increased hazard of death or graft failure (hazard ratio: 1.10; 95% confidence interval: 1.004, 1.21; p = 0.041).

Conclusion

Follow-up outside of a transplant center increased risk of poor outcomes, though the likelihood of receiving care outside a transplant center did not vary by race/ethnicity or socioeconomic status. Our results highlight the need to improve continuity of care after KTx and to further understand the mechanisms leading to poor survival rates among minority populations.

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Data availability

Source data available from United Network for Organ Sharing. Code available from authors upon request.

Code availability

Available from authors upon request.

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Acknowledgements

This study was based on OPTN data as of October 12, 2020.

Funding

Data used in this work was supported in part by Health Resources and Services Administration contract 234–2005-370011C.

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Authors and Affiliations

  1. Department of Pediatrics, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC, 27858, USA

    Olivia Nieto Rickenbach, Dmitry Tumin, Liliana Michelle Gomez Mendez & Hostensia Beng

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  1. Olivia Nieto Rickenbach
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  2. Dmitry Tumin
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  3. Liliana Michelle Gomez Mendez
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  4. Hostensia Beng
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Contributions

DT, LMGM, and HB participated in study conception. ONR, DT, LMGM, and HB participated in study design. DT participated in data acquisition. ONR and DT participated in data analysis. LMGM and HB participated in data interpretation. ONR drafted the manuscript. DT, LMGM, and HB critically revised the manuscript. All authors reviewed the final version of the manuscript and approved it for submission.

Corresponding author

Correspondence to Olivia Nieto Rickenbach.

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Study deemed not human subjects research by Institutional Review Board at East Carolina University.

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The authors declare no competing interests.

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Rickenbach, O.N., Tumin, D., Mendez, L.M.G. et al. Factors associated with follow-up outside a transplant center among pediatric kidney transplant recipients. Pediatr Nephrol 37, 1915–1922 (2022). https://doi.org/10.1007/s00467-021-05397-x

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  • DOI: https://doi.org/10.1007/s00467-021-05397-x

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