Children’s Nutrition Research Center Staff Publications

Language

English

Publication Date

3-21-2025

Journal

Kidney360

DOI

10.34067/KID.0000000724

PMID

40117583

PMCID

PMC12233847

PubMedCentral® Posted Date

3-21-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Key Points:

  1. Pediatric patients residing in low-resource neighborhoods experienced lower rates of preemptive and living donor kidney transplantation.

  2. Household-level factors (single-parent, non-English primary language, and receiving government assistance) may also affect the type of transplant received.

  3. Area Deprivation Index scores offer an objective way to quantify neighborhood-level disadvantage and can enhance pretransplant screening.

Background: Living donor kidney transplant (LDKT) generally results in better outcomes than deceased donor kidney transplant (DDKT). Preemptive kidney transplant (KT) allows patients to bypass undergoing maintenance dialysis and is associated with improved patient and graft survival. Studies in the US pediatric population have shown racial-ethnic disparities in KT listing and the type of transplant received, but have yet to assess the association between neighborhood disadvantage and transplant type (LDKT versus DDKT), access to preemptive KT, or waitlisting.

Methods: The aim of this study was to use geocoded data to quantify neighborhood disadvantage and analyze its effect on access to pediatric KT. A single-center retrospective chart review was conducted of all pediatric KT recipients at Texas Children's Hospital from 2000 to 2022. Patients with multiorgan transplantation, older than 18 years, and with retransplantation were excluded. Transplant type, listing date, and patient address were obtained from the Organ Procurement and Transplantation Network registry. Neighborhood-level disadvantage was categorized using the Area Deprivation Index (ADI) score. ADI scores were calculated on the basis of patient address and transplant year and then stratified into US-based quartiles (Q1=least disadvantaged, Q4=most disadvantaged). Differences in characteristics between groups were determined by chi-square or Fisher's exact test for categorical variables and Kruskal–Wallis test for continuous variables.

Results: There was a significant trend favoring DDKT as ADI quartile increased (Q1=59.1%, Q4=83.5%, P = 0.001). Concurrently, there was a significant decline in preemptive KT rates as ADI quartile increased (Q1=34.1%, Q4=10%, P = 0.001). No preemptive KT or LDKT occurred for Black patients in the most disadvantaged neighborhoods (Q3–4). There was no difference in the time from dialysis to transplant across ADI quartiles.

Conclusions: These findings suggest that pediatric KT recipients from disadvantaged households were less likely to receive a preemptive KT or a LDKT. Using geocoded data can provide an objective assessment of patients' neighborhood disadvantage that supplements subjective pretransplant screening tools.

Keywords

health equity, diversity, and inclusion; pediatric kidney transplantation; pediatric nephrology; social determinants of health

Published Open-Access

yes

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