Decreasing deceased donor transplant rates among children (≤6 years) under the new kidney allocation system |
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| Authors: | Brittany A. Shelton Deirdre Sawinski Christopher Ray Rhiannon D. Reed Paul A. MacLennan Justin Blackburn Carlton J. Young Stephen Gray Megan Yanik Allan Massie Dorry L. Segev Jayme E. Locke |
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| Affiliation: | 1. Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA;2. Penn Transplant Institute, University of Pennsylvania, Philadelphia, PA, USA;3. School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA;4. Department of Pediatrics, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA;5. Johns Hopkins University School of Medicine, Baltimore, MD, USA |
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| Abstract: | The Kidney Allocation System (KAS) was implemented in December 2014 with unknown impact on the pediatric waitlist. To understand the effect of KAS on pediatric registrants, deceased donor kidney transplant (DDKT) rate was assessed using interrupted time series analysis and time‐to‐event analysis. Two allocation eras were defined with an intermediary washout period: Era 1 (01/01/2013‐09/01/2014), Era 2 (09/01/2014‐03/01/2015), and Era 3(03/01/2015‐03/01/2017). When using Cox proportional hazards, there was no significant association between allocation era and DDKT likelihood as compared to Era 1 (Era 3: aHR: 1.07, 95% CI: 0.97‐1.18, P = .17). However, this was not consistent across all subgroups. Specifically, while highly sensitized pediatric registrants were consistently less likely to be transplanted than their less sensitized counterparts, this disparity was attenuated in Era 3 (Era 1 aHR: 0.04, 95%CI: 0.01‐0.14, P < .001; Era 3 aHR: 0.33, 95% CI: 0.21‐0.53, P < .001) whereas the youngest registrants aged 0‐6 experienced a 21% decrease in DDKT likelihood in Era 3 as compared to Era 1 (aHR: 0.79, 95% CI: 0.64‐0.98, P = .03). Thus, while overall DDKT likelihood remained stable with the introduction of KAS, registrants ≤ 6 years of age were disadvantaged, warranting further study to ensure equitable access to transplantation. |
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| Keywords: | health services and outcomes research kidney transplantation/nephrology organ allocation patient survival |
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