Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Pediatr Nephrol. 2023 Apr;38(4):1275-1289. doi: 10.1007/s00467-022-05676-1. Epub 2022 Jul 11.
Disparities in pediatric kidney transplantation (KT) result in reduced access and worse outcomes for minority children. We assessed the impact of recent systems changes on these disparities.
This is a retrospective cohort study of pediatric patients utilizing data from the US Renal Data System (n = 7547) and Scientific Registry of Transplant Recipients (n = 6567 waitlisted and n = 6848 transplanted patients). We compared access to transplantation, time to deceased donor kidney transplant (DDKT), and allograft failure (ACGF) in the 5 years preceding implementation of the Kidney Allocation System (KAS) to the 5 years post-KAS implementation 2010-2014 vs. 2015-2019, respectively.
Compared to the pre-KAS era, post-KAS candidates were more likely to be pre-emptively listed (26.8% vs. 38.1%, p < 0.001), pre-emptively transplanted (23.8% vs. 28.0%, p < 0.001), and less likely to have private insurance (35.6% vs. 32.3%, p = 0.01), but these were not uniform across racial groups. Compared to white children, Black and Hispanic children had a lower likelihood of transplant listing within 2 years of first dialysis service (aHR 0.67 and 0.82, respectively) in the post-KAS era. Time to DDKT was comparable across all racial groups in the post-KAS era. Compared to white children, Black DDKT recipients have more 5-year ACGF (aHR 1.43 p = 0.05) while there was no difference in 3- or 5-year ACGF among LDKT recipients.
After KAS implementation, there is equity in time to DDKT. Pre-KAS increased hazard of ACGF among Black children has decreased in the post-KAS era; however, persistent disparities exist in time to transplant listing among Black and Hispanic children when compared to white children. A higher resolution version of the Graphical abstract is available as Supplementary information.
儿科肾移植（KT）中的差异导致少数族裔儿童获得移植的机会减少，结果更差。我们评估了最近系统变化对这些差异的影响。
这是一项利用美国肾脏数据系统（n=7547）和移植受者科学登记处（n=6567 名等待名单和 n=6848 名移植患者）数据的回顾性队列研究。我们比较了在 2010-2014 年实施肾脏分配系统（KAS）之前的 5 年和之后的 5 年（分别为 2015-2019 年），评估了接受移植的机会、等待死亡供肾移植（DDKT）的时间和移植物失败（ACGF）。
与 KAS 前时代相比，KAS 后候选者更有可能被预先列入名单（26.8% vs. 38.1%，p<0.001），预先接受移植（23.8% vs. 28.0%，p<0.001），而私人保险的可能性较小（35.6% vs. 32.3%，p=0.01），但这些差异并非在所有种族群体中都一致。与白人儿童相比，黑人儿童和西班牙裔儿童在 KAS 后时代，在开始透析服务后 2 年内接受移植的可能性较低（aHR 0.67 和 0.82）。在 KAS 后时代，所有种族群体的 DDKT 时间都相当。与白人儿童相比，黑人 DDKT 受者的 5 年 ACGF 更高（aHR 1.43，p=0.05），而在 LDKT 受者中，3 年和 5 年的 ACGF 没有差异。
KAS 实施后，DDKT 的时间趋于公平。KAS 前增加黑人儿童 ACGF 的风险在 KAS 后时代已经降低；然而，与白人儿童相比，黑人儿童和西班牙裔儿童在获得移植名单的时间上仍然存在差距。
请注意，这只是一个初步的翻译，可能存在一些不准确或不通顺的地方。具体的翻译质量还需要进一步的人工审校和优化。
