NDLI: Geographic determinants of access to pediatric deceased donor kidney transplantation.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Reese, Peter P. Hwang, Hojun Potluri, Vishnu Abt, Peter L. Shults, Justine Amaral, Sandra
Description	Author Affiliation: Reese PP ( Renal-Electrolyte and Hypertension Division, Perelman School of Medicine.)
Abstract	Children receive priority in the allocation of deceased donor kidneys for transplantation in the United States, but because allocation begins locally, geographic differences in population and organ supply may enable variation in pediatric access to transplantation. We assembled a cohort of 3764 individual listings for pediatric kidney transplantation in 2005-2010. For each donor service area, we assigned a category of short (<180 days), medium (181-270 days), or long (>270 days) median waiting time and calculated the ratio of pediatric-quality kidneys to pediatric candidates and the percentage of these kidneys locally diverted to adults. We used multivariable Cox regression analyses to examine the association between donor service area characteristics and time to deceased donor kidney transplantation. The Kaplan-Meier estimate of median waiting time to transplantation was 284 days (95% confidence interval, 263 to 300 days) and varied from 14 to 1313 days across donor service areas. Overall, 29% of pediatric-quality kidneys were locally diverted to adults. Compared with areas with short waiting times, areas with long waiting times had a lower ratio of pediatric-quality kidneys to candidates (3.1 versus 5.9; P<0.001) and more diversions to adults (31% versus 27%; P<0.001). In multivariable regression, a lower kidney to candidate ratio remained associated with longer waiting time (hazard ratio, 0.56 for areas with <2:1 versus reference areas with ≥5:1 kidneys/candidates; P<0.01). Large geographic variation in waiting time for pediatric deceased donor kidney transplantation exists and is highly associated with local supply and demand factors. Future organ allocation policy should address this geographic inequity.
File Format	HTM / HTML
ISSN	10466673
e-ISSN	15333450
DOI	10.1681/ASN.2013070684
Journal	Journal of the American Society of Nephrology
Issue Number	4
Volume Number	25
Language	English
Publisher	American Society of Nephrology
Publisher Date	2014-04-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Nephrology Health Services Accessibility Kidney Transplantation Tissue Donors Supply & Distribution Adolescent Child, Preschool Infant Proportional Hazards Models Waiting Lists Research Support, N.i.h., Extramural
Content Type	Text
Resource Type	Article
Subject	Nephrology

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