Disparities in Access to Timely Waitlisting Among Pediatric Kidney Transplant Candidates

• DOI: 10.1542/peds.2024-065934
• Publication Date: 2024-08-01T08:06:30Z
• Authors: Lindsey M. Maclay; Miko Yu; Sandra Amaral; Joel T. Adler; P. Rodrigo Sandoval; Lloyd E. Ratner; Jesse D. Schold; Sumit Mohan; Syed Ali Husain
• Keywords: Male; Time Factors; Waiting Lists; Adolescent; Kidney Transplantation; Health Services Accessibility; United States; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Renal Dialysis; Child, Preschool; Humans; Kidney Failure, Chronic; Female; Registries; Healthcare Disparities; Child; Retrospective Studies

BACKGROUND AND OBJECTIVES Kidney transplantation with minimal or no dialysis exposure provides optimal outcomes for children end-stage kidney disease. We sought to understand disparities in timely access transplant waitlisting. METHODS conducted a retrospective, registry-based cohort study of candidates ages 3 17 added the US waitlist 2015 2019. defined “preemptive waitlisting” as addition before receiving and compared demographics based on preemptive status. used competing risk regression determine association between waitlisting transplantation. then identified additions age >18 who initiated children, thereby missing pediatric allocation prioritization, evaluated prioritization RESULTS Among 4506 candidates, 48% were waitlisted preemptively. Female sex, Hispanic ethnicity, Black race, public insurance associated lower adjusted relative Preemptive listing was not time from activation (adjusted hazard ratio 0.94, 95% confidence interval 0.87–1.02). recipients preemptively, 68% had pretransplant dialysis, whereas listed nonpreemptively median 1.6 years at transplant. 415 initiating but adults, rate versus nonpreemptive after 0.54, 0.44–0.66). CONCLUSIONS Disparities are differences despite difference activation. Young adults experience delays may miss highlighting an area policy intervention.