The unfinished journey toward transplant equity: an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014.
The unfinished journey toward transplant equity: an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014.
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移植公平的未竟之旅：2014 年肾脏分配系统实施后儿童种族/民族差异分析。
DOI：
10.1007/s00467-022-05676-1
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Verghese,Priya
中科院分区：
文献类型：
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作者：
Charnaya,Olga;Zeiser,Laura;Yisar,Dolev;Goldberg,Aviva;Segev,DorryL;Massie,Allan;Garonzik-Wang,Jacqueline;Verghese,Priya
背景：儿童肾移植(KT)中的缺陷导致少数族裔儿童获得肾移植的机会减少，预后更差。我们评估了最近的系统变化对这些差异的影响。方法这是一项针对儿科患者的回顾性队列研究，使用了来自美国肾脏数据系统(n= 7547)和移植受者科学登记(n= 6567等待名单和n= 6848名移植患者)的数据。我们分别比较了肾分配系统实施前5年与实施肾分配系统后5年的移植获得率、死亡供肾移植时间和移植失败发生率。结果与肾分配系统实施前相比，肾分配系统实施后的候选人更有可能被预先列出(26.8%比38.1%，p<； 0.001)，预先移植(23.8%比28.0%，p<；p<； 0.001)，并且不太可能拥有私人保险(35.6%vs.32.3%，p= 0.001)，但这些在不同种族群体中并不一致。与白人儿童相比，在后KAS时代，黑人和西班牙裔儿童在首次透析服务后两年内被列入移植名单的可能性较低(分别为0.590.670.76和0.730.820.92)。在后KAS时代，所有种族群体达到DDKT的时间是相当的。与白人儿童相比，黑人儿童的5年平均年龄(aHR1.001.432.06p= 0.05)明显高于白人儿童(aHR1.001.432.06p=0.05)，而3年和5年的平均年龄差异无统计学意义。在KAS前，黑人儿童患ACGF的风险在KAS后时代有所下降；然而，与白人儿童相比，黑人和西班牙裔儿童在移植名单上存在持续的差异。图形摘要作为补充信息提供了更高分辨率的图形摘要版本
BackgroundDisparities 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.MethodsThis 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 andn= 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.ResultsCompared 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 (aHR0.590.670.76and0.730.820.92, 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 (aHR1.001.432.06p= 0.05) while there was no difference in 3- or 5-year ACGF among LDKT recipients.ConclusionsAfter 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.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information