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. 2024 Sep 1;154(3):e2024065934.
doi: 10.1542/peds.2024-065934.

Disparities in Access to Timely Waitlisting Among Pediatric Kidney Transplant Candidates

Lindsey M Maclay  1   2 , Miko Yu  1   2 , Sandra Amaral  3   4 , Joel T Adler  5 , P Rodrigo Sandoval  6 , Lloyd E Ratner  6 , Jesse D Schold  7   8 , Sumit Mohan  1   2   9 , Syed Ali Husain  1   2
Affiliations

Disparities in Access to Timely Waitlisting Among Pediatric Kidney Transplant Candidates

Lindsey M Maclay et al. Pediatrics. .

Abstract

Background and objectives: Kidney transplantation with minimal or no dialysis exposure provides optimal outcomes for children with end-stage kidney disease. We sought to understand disparities in timely access to transplant waitlisting.

Methods: We conducted a retrospective, registry-based cohort study of candidates ages 3 to 17 added to the US kidney transplant waitlist 2015 to 2019. We defined "preemptive waitlisting" as waitlist addition before receiving dialysis and compared demographics of candidates based on preemptive status. We used competing risk regression to determine the association between preemptive waitlisting and transplantation. We then identified waitlist additions age >18 who initiated dialysis as children, thereby missing pediatric allocation prioritization, and evaluated the association between waitlisting with pediatric prioritization and transplantation.

Results: Among 4506 pediatric candidates, 48% were waitlisted preemptively. Female sex, Hispanic ethnicity, Black race, and public insurance were associated with lower adjusted relative risk of preemptive waitlisting. Preemptive listing was not associated with time from waitlist activation to transplantation (adjusted hazard ratio 0.94, 95% confidence interval 0.87-1.02). Among transplant recipients waitlisted preemptively, 68% had no pretransplant dialysis, whereas recipients listed nonpreemptively had median 1.6 years of dialysis at transplant. Among 415 candidates initiating dialysis as children but waitlisted as adults, transplant rate was lower versus nonpreemptive pediatric candidates after waitlist activation (adjusted hazard ratio 0.54, 95% confidence interval 0.44-0.66).

Conclusions: Disparities in timely waitlisting are associated with differences in pretransplant dialysis exposure despite no difference in time to transplant after waitlist activation. Young adults who experience delays may miss pediatric prioritization, highlighting an area for policy intervention.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: Dr Mohan receives grant funding from Kidney Transplant Collaborative and the NIH (DK114893, DK116066, DK126739, DK130058 and MD014161), and personal fees from Kidney International Reports, Sanofi and Health Services Advisory Group outside of the submitted work; and the other authors have indicated they have no financial conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence of transplant after (A) waitlisting and (B) waitlist activation among pediatric kidney transplant candidates and adult candidates who initiated dialysis before age 18 years.
See this image and copyright information in PMC

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