Impact of the kidney allocation system on young pediatric recipients |
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Authors: | William Fiske Parker Lainie Friedman Ross J Richard Thistlethwaite Jr Amy E Gallo |
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Institution: | 1. Department of Medicine, University of Chicago, Chicago, IL, USA;2. MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA;3. Department of Pediatrics, University of Chicago, Chicago, IL, USA;4. Department of Surgery, University of Chicago, Chicago, IL, USA;5. Department of Surgery, Stanford University, Palo Alto, CA, USA |
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Abstract: | The kidney allocation system (KAS) altered pediatric candidate prioritization. We determined KAS's impact on pediatric kidney recipients by examining delayed graft function (DGF) rates from 2010 to 2016. A propensity score‐matched pediatric recipients pre‐ and post‐KAS. A semiparametric decomposition analysis estimated the contributions of KAS‐related changes in donor characteristics and dialysis time on DGF rate. The unadjusted odds of DGF were 69% higher post‐KAS for young (<10 years at listing) recipients (N = 1153, P = .02) but were not significantly increased for older pediatric (10‐17 years at listing) recipients (N = 2624, P = .48). Post‐KAS, young recipients received significantly fewer pediatric (<18 years) donor kidneys (21% vs 32%, P < .01) and had longer median pretransplant dialysis time (603 vs 435 days, P < .01). After propensity score matching, post‐KAS status increased the odds of DGF in young recipients 71% (OR 1.71, 95% CI 1.01‐2.46). In decomposition analysis, 24% of the higher DGF rate post‐KAS was attributable to donor characteristics and 19% to increased recipient dialysis time. In a confirmatory survival analysis, DGF was associated with a 2.2 times higher risk of graft failure (aHR2.28, 95% CI 1.46‐3.54). In conclusion, KAS may lead to worse graft survival outcomes in children. Allocation changes should be considered. |
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Keywords: | classification systems delayed graft function pediatric transplantation kidney (allograft) function/dysfunction waitlist management |
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