Decreasing deceased donor transplant rates among children (≤6 years) under the new kidney allocation system

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

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Tissue Donors
Kidney
Transplants
Pediatrics
Vulnerable Populations
Transplantation

Keywords

  • Health services and outcomes research
  • Kidney transplantation/nephrology
  • Organ allocation
  • Patient survival

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Decreasing deceased donor transplant rates among children (≤6 years) under the new kidney allocation system. / Shelton, Brittany A.; Sawinski, Deirdre; Ray, Christopher; Reed, Rhiannon D.; Maclennan, Paul A.; Blackburn, Justin; Young, Carlton J.; Gray, Stephen; Yanik, Megan; Massie, Allan; Segev, Dorry L.; Locke, Jayme E.

In: American Journal of Transplantation, 01.01.2018.

Research output: Contribution to journalArticle

Shelton, BA, Sawinski, D, Ray, C, Reed, RD, Maclennan, PA, Blackburn, J, Young, CJ, Gray, S, Yanik, M, Massie, A, Segev, DL & Locke, JE 2018, 'Decreasing deceased donor transplant rates among children (≤6 years) under the new kidney allocation system', American Journal of Transplantation. https://doi.org/10.1111/ajt.14663
Shelton, Brittany A. ; Sawinski, Deirdre ; Ray, Christopher ; Reed, Rhiannon D. ; Maclennan, Paul A. ; Blackburn, Justin ; Young, Carlton J. ; Gray, Stephen ; Yanik, Megan ; Massie, Allan ; Segev, Dorry L. ; Locke, Jayme E. / Decreasing deceased donor transplant rates among children (≤6 years) under the new kidney allocation system. In: American Journal of Transplantation. 2018.
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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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