Progress made toward equitable transplantation in children and young adults with kidney disease.
Progress made toward equitable transplantation in children and young adults with kidney disease.
复制标题
患有肾病的儿童和年轻人在公平移植方面取得了进展。
DOI：
10.1007/s00467-024-06309-5
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Laster,Marciana
中科院分区：
文献类型：
--
作者：
Harford,Mercedes;Laster,Marciana
在过去的二十年里，儿童肾移植中的种族差异已经得到了很好的描述，包括先发制人移植、等待名单、从激活到移植的时间、活体捐献和移植结果方面的差异。器官分配制度的变化，包括2005年的35人分配制和2014年的肾脏分配制度，解决了一些但不是全部的种族-族裔差异。尽管从等待名单激活到移植的时间总体上有所改善，但在先发制人移植、等待名单时间和活体供者移植方面仍然存在差异。尽管在KAS下有所改善，但在移植物存活率方面，种族差异仍然存在。肾移植获得性和移植物存活率方面的种族差异是儿科肾病中的一个国际问题。尽管受影响的种族群体可能不同，但世界各地各种小儿科群体都受到移植差异的影响。健康的社会决定因素，包括经济来源、语言障碍和健康的活体捐赠者的存在，在调解这些差异方面发挥了作用。需要进一步的研究，以更好地了解和干预可改变的社会、生物和文化因素，这些因素导致移植结果之间的剩余差异。
Racial disparities in pediatric kidney transplantation have been well described over the last two decades and include disparities in preemptive transplantation, waitlisting, time from activation to transplantation, living donation, and graft outcomes. Changes to the organ allocation system including the institution of Share 35 in 2005 and the Kidney Allocation System (KAS) of 2014 have resulted in resolution of some, but not all racial-ethnic disparities. Despite overall improvements in time from waitlist activation to transplant, disparities remain in preemptive transplantation, time to waitlisting, and living donor transplantation. Although improving under the KAS, racial disparities remain in graft survival as well. Racial disparity in kidney transplant access and graft survival is an international problem within pediatric nephrology. Although the racial group affected may differ, various minoritized pediatric groups across the world are affected by transplant disparities. Social determinants of health including financial access, language barriers, and the presence of a healthy living donor play a role in mediating these disparities. Further investigation is needed to better understand and intervene upon modifiable social, biological, and cultural factors driving the remaining disparity in transplant outcomes.