Abstract
BACKGROUND: Disparities in pediatric kidney transplantation (KT) result in reduced access and worse outcomes for minority children. We assessed the impact of recent systems changes on these disparities. METHODS: This is a retrospective cohort study of pediatric patients utilizing data from the US Renal Data System (n = 7547) and Scientific Registry of Transplant Recipients (n = 6567 waitlisted and n = 6848 transplanted patients). We compared access to transplantation, time to deceased donor kidney transplant (DDKT), and allograft failure (ACGF) in the 5 years preceding implementation of the Kidney Allocation System (KAS) to the 5 years post-KAS implementation 2010-2014 vs. 2015-2019, respectively. RESULTS: Compared to the pre-KAS era, post-KAS candidates were more likely to be pre-emptively listed (26.8% vs. 38.1%, p < 0.001), pre-emptively transplanted (23.8% vs. 28.0%, p >< 0.001), and less likely to have private insurance (35.6% vs. 32.3%, p =" 0.01)," but these were not uniform across racial groups. compared to white children, black and hispanic children had a lower likelihood of transplant listing within 2 years of first dialysis service (ahr 0.590.670.76 and 0.730.820.92, respectively) in the post-kas era. time to ddkt was comparable across all racial groups in the post-kas era. compared to white children, black ddkt recipients have more 5-year acgf (ahr 1.001.432.06 p =" 0.05)" while there was no difference in 3- or 5-year acgf among ldkt recipients. conclusions: after kas implementation, there is equity in time to ddkt. pre-kas increased hazard of acgf among black children has decreased in the post-kas era; however, persistent disparities exist in time to transplant listing among black and hispanic children when compared to white children. a higher resolution version of the graphical abstract is available as supplementary information.>
