Kidney Allocation System helped limit racial disparities, increased transplant wait time
Click Here to Manage Email Alerts
Five years after the Kidney Allocation System was implemented, racial and ethnic disparities decreased in pediatric transplantations but the wait time for kidney transplants increased for pediatric patients of all races and ethnicities.
To reduce racial and ethnic disparities in pediatric kidney transplantation, the Kidney Allocation System (KAS) was put into effect in 2014. The intended goal was to provide more access to transplants for sensitized candidates.
“A lot of the studies describing racial and ethnic disparities in pediatric kidney transplantation pre-date this policy change,” Jill R. Krissberg, MD, MS, an attending physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and assistant professor of pediatrics in the division of nephrology at Northwestern University Feinberg School of Medicine, told Healio. “Since a major driving force behind the policy change was to help reduce racial and ethnic disparities, it was time for a study that assessed this policy with longer follow-up time after its implementation. Furthermore, we wanted to elevate the voice of children and really highlight how this policy change was specifically affecting children waiting for kidney transplants.”
In a retrospective cohort study of children, researchers tracked all patients aged younger than 18 who were active on the kidney transplant list from 2008 to 2019 using the Scientific Registry of Transplant Recipients.
Krissberg and colleagues identified time from first activation on the transplant list and time on dialysis to deceased-donor transplant using log-logistic accelerated failure time models. The exposure of interest was either the KAS era or race and ethnicity.
Additionally, logistic regression was used to evaluate odds of delayed graft function, and log-rank tests measured time to graft loss among racial and ethnic groups across KAS eras.
“An unintended consequence of the policy change may be that it is limiting accessibility to kidney transplantation for children overall,” Krissberg told Healio. “We were surprised to see that children of all racial and ethnic groups waited longer for transplantation after the policy change.”
Although all patients experienced increased wait times, Black, Hispanic or “other children of color” waited longer compared with white children in both eras (time ratio 1.16 (95% CI 1.01-1.32); 1.13 (1.00-1.28); 1.17 (0.96-1.41) post-KAS, respectively), according to an univariable analysis.
Multivariable analysis revealed that racial and ethnic disparities in the period from dialysis initiation to transplantation in the pre-KAS era decreased in the post-KAS era. While there were no disparities in odds of delayed graft function, Black or Hispanic children experienced longer times with a functioning graft in the post-KAS era.
“The univariate analysis of this study showed longer times from activation to transplantation for children of color compared to white children—findings that were largely attenuated in multivariate analysis. This finding was relatively the same before and after the policy change,” Krissberg told Healio.
In an American Society of Nephrology press release, Krissberg said, “Times were even only after adjusting for patient- and transplant-related factors—such as blood type, age, where someone lives—meaning there are other factors affecting access to transplant for children of color that still need to be explored.”
Krissberg told Healio that future policies focused on achieving “health equity” should pay attention to patient-specific barriers and the social determinants of health that could be limiting children of color access to transplantations.
Reference:
- Has 2014 policy change affected racial disparities in pediatric kidney transplantation? https://www.newswise.com/articles/has-2014-policy-change-affected-racial-disparities-in-pediatric-kidney-transplantation?sc=cwhr&xy=10007438. Published Oct. 15, 2021. Accessed Nov. 2, 2021.
Collapse
Click Here to Manage Email Alerts