Nogueira Paulo Cesar Koch, de Carvalho Maria Fernanda Camargo, de Santis Feltran Luciana, Konstantyner Tulio, Sesso Ricardo
Pediatric Renal Transplant Service, Hospital Samaritano de São Paulo, Sao Paulo, Sao Paulo, Brazil.
Pediatrics Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Sao Paulo, Brazil.
Pediatr Nephrol. 2016 Mar;31(3):501-7. doi: 10.1007/s00467-015-3226-z. Epub 2015 Oct 19.
The aim of this study was to describe the access and factors associated with kidney transplantation for children in different regions of Brazil.
We analyzed a cohort of 1211 children enrolled on the transplant list from January 2011 to December of 2013. We fitted regression models to investigate factors associated with: (a) undergoing kidney transplantation from a deceased donor, and (b) being removed from the waiting list.
The incidence of transplantation was uneven across regions, with the lowest rate at 0.4 per million age-related population (pmarp) in the Midwest and the highest incidence rate of 8.3 cases pmarp in the South. Children from the North and the Midwest regions had a 3-4 times lower probability of undergoing a deceased donor transplant (p < 0.05). Apart from the geographic region, age of recipients and GDP influenced the outcome. The likelihood of undergoing transplantation was very low in the youngest children in the North and Midwest. The number of transplant centers was not associated with either outcome.
Factors of inequality in transplantation in Brazil are of macroeconomic origin, but there is room to reduce inequalities. Training existing transplant center professionals in the care of children could diminish the discrepancies.
本研究旨在描述巴西不同地区儿童肾移植的可及性及相关因素。
我们分析了2011年1月至2013年12月登记在移植名单上的1211名儿童队列。我们拟合回归模型以研究与以下因素相关的因素：（a）接受来自 deceased 供体的肾移植，以及（b）从等待名单中移除。
各地区移植发生率不均衡，中西部地区每百万年龄相关人口（pmarp）的发生率最低，为0.4，南部地区最高，为8.3例/pmarp。北部和中西部地区的儿童接受 deceased 供体移植的概率低3至4倍（p < 0.05）。除地理区域外，受者年龄和国内生产总值影响结果。北部和中西部最年幼的儿童接受移植的可能性非常低。移植中心的数量与任何一个结果均无关联。
巴西移植中的不平等因素源于宏观经济，但仍有减少不平等的空间。对现有移植中心专业人员进行儿童护理培训可减少差异。
