Geographic determinants of access to pediatric deceased donor kidney transplantation.

TitleGeographic determinants of access to pediatric deceased donor kidney transplantation.
Publication TypeJournal Article
Year of Publication2014
AuthorsReese PP, Hwang H, Potluri V, Abt PL, Shults J, Amaral S
JournalJ Am Soc Nephrol
Date Published2014 Apr
KeywordsAdolescent, Child, Child, Preschool, Female, Health Services Accessibility, Humans, Infant, Kidney Transplantation, Male, Proportional Hazards Models, Tissue Donors, Waiting Lists

Children receive priority in the allocation of deceased donor kidneys for transplantation in the United States, but because allocation begins locally, geographic differences in population and organ supply may enable variation in pediatric access to transplantation. We assembled a cohort of 3764 individual listings for pediatric kidney transplantation in 2005-2010. For each donor service area, we assigned a category of short (<180 days), medium (181-270 days), or long (>270 days) median waiting time and calculated the ratio of pediatric-quality kidneys to pediatric candidates and the percentage of these kidneys locally diverted to adults. We used multivariable Cox regression analyses to examine the association between donor service area characteristics and time to deceased donor kidney transplantation. The Kaplan-Meier estimate of median waiting time to transplantation was 284 days (95% confidence interval, 263 to 300 days) and varied from 14 to 1313 days across donor service areas. Overall, 29% of pediatric-quality kidneys were locally diverted to adults. Compared with areas with short waiting times, areas with long waiting times had a lower ratio of pediatric-quality kidneys to candidates (3.1 versus 5.9; P<0.001) and more diversions to adults (31% versus 27%; P<0.001). In multivariable regression, a lower kidney to candidate ratio remained associated with longer waiting time (hazard ratio, 0.56 for areas with <2:1 versus reference areas with ≥5:1 kidneys/candidates; P<0.01). Large geographic variation in waiting time for pediatric deceased donor kidney transplantation exists and is highly associated with local supply and demand factors. Future organ allocation policy should address this geographic inequity.

Alternate JournalJ. Am. Soc. Nephrol.
PubMed ID24436470
PubMed Central IDPMC3968505
Grant ListK23-DK078688 / DK / NIDDK NIH HHS / United States
K23-DK083529 / DK / NIDDK NIH HHS / United States