Fairless Brandon M, Fawole Oluwatunmise A, Nguyen Duc T, Banerjee Ankona, Nobleza Kenneth J, Oluyomi Abiodun O, Rosales Omar, Dave Jayna M, Onugha Elizabeth A
Division of Pediatric Nephrology, Baylor College of Medicine, Houston, Texas.
Department of Internal Medicine-Pediatrics, Baylor College of Medicine, Houston, Texas.
Kidney360. 2025 Mar 21;6(6):1007-1019. doi: 10.34067/KID.0000000724.
Pediatric patients residing in low-resource neighborhoods experienced lower rates of preemptive and living donor kidney transplantation. Household-level factors (single-parent, non-English primary language, and receiving government assistance) may also affect the type of transplant received. Area Deprivation Index scores offer an objective way to quantify neighborhood-level disadvantage and can enhance pretransplant screening.
Living donor kidney transplant (LDKT) generally results in better outcomes than deceased donor kidney transplant (DDKT). Preemptive kidney transplant (KT) allows patients to bypass undergoing maintenance dialysis and is associated with improved patient and graft survival. Studies in the US pediatric population have shown racial-ethnic disparities in KT listing and the type of transplant received, but have yet to assess the association between neighborhood disadvantage and transplant type (LDKT versus DDKT), access to preemptive KT, or waitlisting.
The aim of this study was to use geocoded data to quantify neighborhood disadvantage and analyze its effect on access to pediatric KT. A single-center retrospective chart review was conducted of all pediatric KT recipients at Texas Children's Hospital from 2000 to 2022. Patients with multiorgan transplantation, older than 18 years, and with retransplantation were excluded. Transplant type, listing date, and patient address were obtained from the Organ Procurement and Transplantation Network registry. Neighborhood-level disadvantage was categorized using the Area Deprivation Index (ADI) score. ADI scores were calculated on the basis of patient address and transplant year and then stratified into US-based quartiles (Q1=least disadvantaged, Q4=most disadvantaged). Differences in characteristics between groups were determined by chi-square or Fisher's exact test for categorical variables and Kruskal–Wallis test for continuous variables.
There was a significant trend favoring DDKT as ADI quartile increased (Q1=59.1%, Q4=83.5%, = 0.001). Concurrently, there was a significant decline in preemptive KT rates as ADI quartile increased (Q1=34.1%, Q4=10%, = 0.001). No preemptive KT or LDKT occurred for Black patients in the most disadvantaged neighborhoods (Q3–4). There was no difference in the time from dialysis to transplant across ADI quartiles.
These findings suggest that pediatric KT recipients from disadvantaged households were less likely to receive a preemptive KT or a LDKT. Using geocoded data can provide an objective assessment of patients' neighborhood disadvantage that supplements subjective pretransplant screening tools.
居住在资源匮乏社区的儿科患者接受先发制和活体供肾移植的比例较低。家庭层面的因素（单亲、非英语母语以及接受政府援助）也可能影响所接受的移植类型。地区贫困指数得分提供了一种量化社区层面劣势的客观方法，并且可以加强移植前筛查。
活体供肾移植（LDKT）通常比尸体供肾移植（DDKT）产生更好的结果。先发制肾移植（KT）使患者无需进行维持性透析，并且与改善患者和移植物存活率相关。美国儿科人群的研究已经显示了KT登记和所接受移植类型方面的种族和族裔差异，但尚未评估社区劣势与移植类型（LDKT与DDKT）、先发制KT的可及性或列入等待名单之间的关联。
本研究的目的是使用地理编码数据来量化社区劣势，并分析其对儿科KT可及性的影响。对2000年至2022年在德克萨斯儿童医院接受所有儿科KT的患者进行了单中心回顾性病历审查。排除了接受多器官移植、年龄超过18岁以及再次移植的患者。移植类型、登记日期和患者地址从器官获取和移植网络登记处获得。使用地区贫困指数（ADI）得分对社区层面的劣势进行分类。ADI得分根据患者地址和移植年份计算，然后分层为基于美国的四分位数（Q1 = 最不贫困，Q4 = 最贫困）。通过卡方检验或Fisher精确检验确定分类变量组间特征的差异，通过Kruskal–Wallis检验确定连续变量组间特征的差异。
随着ADI四分位数增加，倾向于DDKT的趋势显著（Q1 = 59.1%，Q4 = 83.5%，P = 0.001）。同时，随着ADI四分位数增加，先发制KT率显著下降（Q1 = 34.1%，Q4 = 10%，P = 0.001）。在最贫困社区（Q3 - 4）的黑人患者中未发生先发制KT或LDKT。各ADI四分位数从透析到移植的时间没有差异。
这些发现表明，来自弱势家庭的儿科KT受者接受先发制KT或LDKT的可能性较小。使用地理编码数据可以提供对患者社区劣势的客观评估，这补充了主观的移植前筛查工具。
