1
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Sandal S, Ahn J, Chen Y, Thompson V, Purnell TS, Cantarovich M, Clark-Cutaia MN, Wu W, Suri R, Segev DL, McAdams-DeMarco M. Differences in Racial and Ethnic Disparities Between First and Repeat Kidney Transplantation. Transplantation 2024:00007890-990000000-00761. [PMID: 38771099 DOI: 10.1097/tp.0000000000005051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Recent data suggest patients with graft failure had better access to repeat kidney transplantation (re-KT) than transplant-naive dialysis accessing first KT. This was postulated to be because of better familiarity with the transplant process and healthcare system; whether this advantage is equitably distributed is not known. We compared the magnitude of racial/ethnic disparities in access to re-KT versus first KT. METHODS Using United States Renal Data System, we identified 104 454 White, Black, and Hispanic patients with a history of graft failure from 1995 to 2018, and 2 357 753 transplant-naive dialysis patients. We used adjusted Cox regression to estimate disparities in access to first and re-KT and whether the magnitude of these disparities differed between first and re-KT using a Wald test. RESULTS Black patients had inferior access to both waitlisting and receiving first KT and re-KT. However, the racial/ethnic disparities in waitlisting for (adjusted hazard ratio [aHR] = 0.77; 95% confidence interval [CI], 0.74-0.80) and receiving re-KT (aHR = 0.61; 95% CI, 0.58-0.64) was greater than the racial/ethnic disparities in first KT (waitlisting: aHR = 0.91; 95% CI, 0.90-0.93; Pinteraction = 0.001; KT: aHR = 0.68; 95% CI, 0.64-0.72; Pinteraction < 0.001). For Hispanic patients, ethnic disparities in waitlisting for re-KT (aHR = 0.83; 95% CI, 0.79-0.88) were greater than for first KT (aHR = 1.14; 95% CI, 1.11-1.16; Pinteraction < 0.001). However, the disparity in receiving re-KT (aHR = 0.76; 95% CI, 0.72-0.80) was similar to that for first KT (aHR = 0.73; 95% CI, 0.68-0.79; Pinteraction = 0.55). Inferences were similar when restricting the cohorts to the Kidney Allocation System era. CONCLUSIONS Unlike White patients, Black and Hispanic patients with graft failure do not experience improved access to re-KT. This suggests that structural and systemic barriers likely persist for racialized patients accessing re-KT, and systemic changes are needed to achieve transplant equity.
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Affiliation(s)
- Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - JiYoon Ahn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yusi Chen
- Department of Surgery, NYU Grossman School of Medicine and Langone Health, New York, NY
| | - Valerie Thompson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, NYU Grossman School of Medicine and Langone Health, New York, NY
| | - Marcelo Cantarovich
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Wenbo Wu
- Department of Population Health, NYU Grossman School of Medicine and Langone Health, New York, NY
| | - Rita Suri
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and Langone Health, New York, NY
- Department of Population Health, NYU Grossman School of Medicine and Langone Health, New York, NY
| | - Mara McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and Langone Health, New York, NY
- Department of Population Health, NYU Grossman School of Medicine and Langone Health, New York, NY
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2
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Custodio LDFP, Martins SBS, Viana LA, Cristelli MP, Requião-Moura L, Chow CYZ, Camargo SFDN, Nakamura MR, Foresto RD, Tedesco-Silva H, Medina-Pestana J. Efficacy and safety of single-dose anti-thymocyte globulin versus basiliximab induction therapy in pediatric kidney transplant recipients: A retrospective comparative cohort study. Pediatr Transplant 2024; 28:e14713. [PMID: 38553819 DOI: 10.1111/petr.14713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND This study aimed to compare the efficacy and safety of basiliximab (BAS) versus a single dose of anti-thymocyte globulin (r-ATG) induction therapy in pediatric kidney transplant recipients (KTRs). METHODS This single-center retrospective comparative cohort study included all pediatric KTRs from May 2013 to April 2018 and followed up to 12 months. In the first period, all recipients received BAS, while from May 2016, a single 3 mg/kg dose of r-ATG was instituted. Maintenance therapy consisted of a calcineurin inhibitor plus prednisone plus azathioprine or mycophenolate. RESULTS A total of 227 patients were included (BAS, n = 113; r-ATG, n = 114). The main combination of immunosuppressive drugs was tacrolimus, prednisone, and azathioprine in both groups (87% vs. 88%, p = .718). Patients receiving r-ATG showed superior survival-free of the composite endpoint (acute rejection, graft loss, or death; 76% vs. 61%, p = .003; HR 2.08, 1.29-3.34, p = .003) and lower incidence of biopsy-proven acute rejection (10% vs. 21%, p = .015). There was no difference in the overall incidence of CMV infection (33% vs. 37%, p = .457), PTLD (1% vs. 3%, p = .309), 30-day hospital readmissions (24% vs. 23%, p = .847), and kidney function at 12 months (86 ± 29 vs. 84 ± 30 mL/min/1.73m2, p = .614). CONCLUSIONS These data suggest that induction therapy with a single 3 mg/kg dose of r-ATG is associated with higher efficacy for preventing acute rejection and similar safety profile compared to BAS.
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Affiliation(s)
| | | | | | | | - Lucio Requião-Moura
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Helio Tedesco-Silva
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jose Medina-Pestana
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
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3
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Harford M, Laster M. Progress made toward equitable transplantation in children and young adults with kidney disease. Pediatr Nephrol 2024:10.1007/s00467-024-06309-5. [PMID: 38347281 DOI: 10.1007/s00467-024-06309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 05/16/2024]
Abstract
Racial disparities in pediatric kidney transplantation have been well described over the last two decades and include disparities in preemptive transplantation, waitlisting, time from activation to transplantation, living donation, and graft outcomes. Changes to the organ allocation system including the institution of Share 35 in 2005 and the Kidney Allocation System (KAS) of 2014 have resulted in resolution of some, but not all racial-ethnic disparities. Despite overall improvements in time from waitlist activation to transplant, disparities remain in preemptive transplantation, time to waitlisting, and living donor transplantation. Although improving under the KAS, racial disparities remain in graft survival as well. Racial disparity in kidney transplant access and graft survival is an international problem within pediatric nephrology. Although the racial group affected may differ, various minoritized pediatric groups across the world are affected by transplant disparities. Social determinants of health including financial access, language barriers, and the presence of a healthy living donor play a role in mediating these disparities. Further investigation is needed to better understand and intervene upon modifiable social, biological, and cultural factors driving the remaining disparity in transplant outcomes.
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Affiliation(s)
- Mercedes Harford
- Division of Nephrology, Department of Pediatrics, School of Medicine, Indiana University, 699 Riley Hospital Drive, Rm 230, Indianapolis, IN, 46202, USA
| | - Marciana Laster
- Division of Nephrology, Department of Pediatrics, School of Medicine, Indiana University, 699 Riley Hospital Drive, Rm 230, Indianapolis, IN, 46202, USA.
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4
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Dawson AE, Ray Bignall ON, Spencer JD, McLeod DJ. A Call to Comprehensively Understand Our Patients to Provide Equitable Pediatric Urological Care. Urology 2023; 179:126-135. [PMID: 37393019 DOI: 10.1016/j.urology.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Anne E Dawson
- Division of Psychology and Neuropsychology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio; The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio
| | - O N Ray Bignall
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio; Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - John David Spencer
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio; Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Daryl J McLeod
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio; Department of Urology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
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5
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Berkman ER, Richardson KL, Clark JD, Dick AAS, Lewis-Newby M, Diekema DS, Wightman AG. An ethical analysis of obesity as a contraindication of pediatric kidney transplant candidacy. Pediatr Nephrol 2023; 38:345-356. [PMID: 35488137 DOI: 10.1007/s00467-022-05572-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/10/2023]
Abstract
The inclusion of body mass index (BMI) as a criterion for determining kidney transplant candidacy in children raises clinical and ethical challenges. Childhood obesity is on the rise and common among children with kidney failure. In addition, obesity is reported as an independent risk factor for the development of CKD and kidney failure. Resultantly, more children with obesity are anticipated to need kidney transplants. Most transplant centers around the world use high BMI as a relative or absolute contraindication for kidney transplant. However, use of obesity as a relative or absolute contraindication for pediatric kidney transplant is controversial. Empirical data demonstrating poorer outcomes following kidney transplant in obese pediatric patients are limited. In addition, pediatric obesity is distributed inequitably among groups. Unlike adults, most children lack independent agency to choose their food sources and exercise opportunities; they are dependent on their families for these choices. In this paper, we define childhood obesity and review (1) the association and impact of obesity on kidney disease and kidney transplant, (2) existing adult guidelines and rationale for using high BMI as a criterion for kidney transplant, (3) the prevalence of childhood obesity among children with kidney failure, and (4) the existing literature on obesity and pediatric kidney transplant outcomes. We then discuss ethical considerations related to the use of obesity as a criterion for kidney transplant.
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Affiliation(s)
- Emily R Berkman
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Kelsey L Richardson
- Division of Pediatric Nephrology, Oregon Health Sciences University, Portland, OR, USA
| | - Jonna D Clark
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - André A S Dick
- Division of Transplantation, Section of Pediatric Transplantation, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Mithya Lewis-Newby
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Cardiac Critical Care, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Douglas S Diekema
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Pediatric Emergency Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Aaron G Wightman
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Pediatric Nephrology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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6
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Butani L, Tancredi D. Outcomes of living unrelated donor kidney transplants in children: An Organ Procurement and Transplant Network database analysis. Pediatr Transplant 2022; 26:e14368. [PMID: 35869899 DOI: 10.1111/petr.14368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/03/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are conflicting data on long-term outcomes of pediatric LURD renal Txs compared to Txs of kidneys from other donor sources. METHODS An analysis of the OPTN database was conducted in children (<18 years) who had received their 1st kidney-only Tx between January 1, 2000, and September 30, 2021. The primary outcome measure was time to graft failure or death. Cox event history regression model for time to primary outcome, categorized by donor source and adjusting for confounders was performed. RESULTS Of the 12 089 subjects, 327 (2.7%) received kidneys from LURDs, 4349 (36%) from LRDs and 7413 (61%) from DD. One year graft failure rate was 3.56%. On regression analyses, compared to LRD kidney recipients, LURD recipients had comparable graft survival (graft failure AHR 1.15, 95th percentile confidence interval 0.87-1.51; p .31) and DD recipients had lower graft survival (graft failure hazard ratio 1.26, 95th percentile confidence interval 1.10-1.43; p < .001). When using living unrelated kidney recipients as the reference group, DD kidney recipients had comparable graft survival, with a wide confidence interval (hazard ratio for graft failure 1.09; 0.83-1.43, p .53). CONCLUSIONS Pediatric LURD kidney recipients have comparable graft survival to LRD kidney recipients; DD kidney recipients had the poorest survival. Our study, the largest to date, should encourage centers to embrace non-commercial living-unrelated transplantation as a viable option for children, preferable to DD kidneys.
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Affiliation(s)
- Lavjay Butani
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
| | - Daniel Tancredi
- Department of Pediatrics and the Center for Healthcare Policy and Research, University of California Davis Medical Center, Sacramento, California, USA
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7
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Pruette CS, Ranch D, Shih WV, Ferris MDG. Health Care Transition in Adolescents and Young Adults With Chronic Kidney Disease: Focus on the Individual and Family Support Systems. Adv Chronic Kidney Dis 2022; 29:318-326. [PMID: 36084978 DOI: 10.1053/j.ackd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
Health care transition (HCT) from pediatric to adult-focused services is a longitudinal process driven by the collaboration and interactions of adolescent/young adult patients, their families, providers, health care agencies, and environment. Health care providers in both pediatric and adult-focused settings must collaborate, as patients' health self-management skills are acquired in the mid-20s, after they have transferred to adult-focused care. Our manuscript discusses the individual and family support systems as they relate to adolescents and young adults with chronic or end-stage kidney disease. In the individual domain, we discuss demographic/socioeconomic characteristics, disease complexity/course, cognitive capabilities, and self-management/self-advocacy. In the family domain, we discuss family composition/culture factors, family function, parenting style, and family unit factors. We provide a section dedicated to patients with cognitive and developmental disability. Furthermore, we discuss barriers for HCT preparation and offer solutions as well as activities for HCT preparation.
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Affiliation(s)
| | - Daniel Ranch
- Department of Pediatrics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
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8
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Chhiba PD, Moore DP, Levy C, Do Vale C. Factors associated with graft survival in South African adolescent renal transplant patients at CMJAH over a 20-year period (GRAFT-SAT Study). Pediatr Transplant 2022; 26:e14148. [PMID: 34569127 DOI: 10.1111/petr.14148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the developed world, studies on transition of adolescent renal transplant patients have noted high rates of rejection, non-adherence and graft loss. There is a paucity of data in developing countries and none from South Africa. METHODS We evaluated patient and graft outcomes during adolescence (10-19 years), of patients who received a renal transplant over a 20-year period (1990-2010), at a tertiary hospital in Johannesburg. Cox proportional hazards models and Kaplan-Meier curves were used to analyse graft and patient survival. RESULTS A total of 213 kidney transplants were done in 162 patients during the study period, 165 transplants occurred during the adolescent period. Factors associated with graft failure on multivariate analysis included non-white race, transplant during the adolescent period ([aHR] 3.94; 95% [CI], 2.25-6.91), non-compliance with follow-up (aHR 3.89; 95% CI, 1.76-8.60) and receipt of a DD graft (aHR 2.10; 95% CI, 1.27-3.48). Patient survival rates at 1-, 3-, 5- and 10-years were 98.8%, 97.6%, 95.1% and 93.9% respectively. CONCLUSION High rates of graft rejection and loss occurred in South African renal transplant recipients in the adolescent period, especially in those retained in paediatric care. Establishment of transition clinics may improve the graft outcomes of this vulnerable group and warrant further research.
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Affiliation(s)
- Priya Darshani Chhiba
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David P Moore
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cecil Levy
- Department of Paediatrics, Nelson Mandela Children's Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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9
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Becerra A, Chan K, Eggers P, Norton J, Kimmel P, Schulman I, Mendley S. Transplantation Mediates Much of the Racial Disparity in Survival from Childhood-onset Kidney Failure. J Am Soc Nephrol 2022; 33:1265-1275. [PMID: 35078941 PMCID: PMC9257803 DOI: 10.1681/asn.2021071020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/13/2022] [Indexed: 11/03/2022] Open
Abstract
Background: The role of kidney transplantation in differential survival in Black and White patients with childhood-onset kidney failure is unexplored. Methods: We analyzed 30-year cohort data of children beginning renal replacement therapy (RRT) before age 18 between January 1980 and December 2017 (n=28,337) in the U.S. Renal Data System. Cox regression identified transplant factors associated with survival by race. The survival mediational g-formula estimated the excess mortality among Black patients that could be eliminated if an intervention equalized their time with a transplant to that of White patients. Results: Black children comprised 24% of the cohort and their crude 30-year survival was 39% compared to 57% for White children (log rank p<0.001). Black children had 45% higher risk of death (adjusted hazard ratio (aHR) 1.45, 95% confidence interval (CI) 1.36, 1.54) and 31% lower incidence of first transplant (aHR 0.69, 95% CI 0.67, 0.72), and 39% lower incidence of second transplant (aHR 0.61, CI 0.57, 0.65). Children and young adults are likely to require multiple transplants, yet even after their first transplant, Black patients had 11% fewer total transplants (adjusted incidence rate ratio (aIRR) 0.89, 95% CI 0.86, 0.92). In Black patients grafts failed earlier after first and second transplants. Overall,Black patients spent 24% less of their RRT time with a transplant than did White patients (aIRR 0.76, 95% CI 0.74, 0.78). Transplantation compared with dialysis strongly protected against death (aHR 0.28, 95% CI 0.16, 0.48) by timevarying analysis. Mediation analyses estimated that equalizing transplant duration could prevent 35% (p<.001) of excess deaths in Black patients. Conclusions: Equalizing time with a functioning transplant for Black patients may equalize survival of childhood-onset ESRD with White patients.
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Affiliation(s)
- Adan Becerra
- A Becerra, Department of Public Health Sciences, Social & Scientific Systems Inc, Silver Spring, United States
| | | | - Paul Eggers
- P Eggers, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States
| | - Jenna Norton
- J Norton, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States
| | - Paul Kimmel
- P Kimmel, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States
| | - Ivonne Schulman
- I Schulman, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States
| | - Susan Mendley
- S Mendley, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, United States
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10
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Varnell CD, Rich KL, Zhang B, Carle AC, Pai ALH, Modi AC, Hooper DK. Predicting acute rejection in children, adolescents, and young adults with a kidney transplant by assessing barriers to taking medication. Pediatr Nephrol 2021; 36:2453-2461. [PMID: 33501558 PMCID: PMC8263481 DOI: 10.1007/s00467-021-04946-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/15/2020] [Accepted: 01/12/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Nonadherence to immunosuppression is common among pediatric, adolescent, and young adult kidney transplant recipients and a leading cause of graft loss. Assessing barriers to medication adherence in clinical practice may identify patients at risk for rejection and provide therapeutic targets. METHODS Kidney transplant patients and/or their caregivers were assessed for 14 barriers to medication adherence using the barriers assessment tool. We compared rejection rates between patients with at least one reported adherence barrier to those without reported adherence barriers using a Kaplan-Meier estimator and Cox proportional hazard models to adjust for other mediators of acute rejection at 2 years following barriers assessment. RESULTS Ninety-eight patients were assessed for barriers to adherence. Over the 2-year observation period, 22 patients developed biopsy-proven acute rejection (BPAR). Kaplan-Meier estimates show that patients with an identified barrier to adherence were more likely to have BPAR (p = 0.02) than patients without an identified barrier in the 24 months following barriers assessment. The median time to rejection for patients who experienced acute rejection was 175.5 days (IQR 63-276 days) from the time of barriers assessment. An identified barrier to adherence remained the only statistically significant predictor of BPAR with Cox modeling (HR 2.6, p = 0.04), after accounting for age, sex, and race. CONCLUSIONS Pediatric and adolescent kidney transplant recipients with identified adherence barriers are at increased risk for acute rejection. Barriers to adherence provide a potentially modifiable therapeutic target that can be assessed in clinic to guide targeted interventions.
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Affiliation(s)
- Charles D Varnell
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH, 45229, USA. .,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Kristin L Rich
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bin Zhang
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam C Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Ahna L H Pai
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Avani C Modi
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David K Hooper
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH, 45229, USA.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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11
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Policy in pediatric nephrology: successes, failures, and the impact on disparities. Pediatr Nephrol 2021; 36:2177-2188. [PMID: 32968856 DOI: 10.1007/s00467-020-04755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/10/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Pediatric nephrology has a history rooted in pediatric advocacy and has made numerous contributions to child health policy affecting pediatric kidney diseases. Despite this progress, profound social disparities remain for marginalized and socially vulnerable children with kidney disease. Different risk factors, such as genetic predisposition, environmental factors, social risk factors, or health care access influence the emergence and progression of pediatric kidney disease, as well as access to life-saving interventions, leading to disparate outcomes. This review will summarize the breadth of literature on social determinants of health in children with kidney disease worldwide and highlight policy-based initiatives that mitigate the adverse social factors to generate greater equity in pediatric kidney disease.
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12
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Anand A, Malik TH, Dunson J, McDonald MF, Christmann CR, Galvan NTN, O'Mahony C, Goss JA, Srivaths PR, Brewer ED, Rana A. Factors associated with long-term graft survival in pediatric kidney transplant recipients. Pediatr Transplant 2021; 25:e13999. [PMID: 33704871 DOI: 10.1111/petr.13999] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/22/2020] [Accepted: 02/24/2021] [Indexed: 12/13/2022]
Abstract
Pediatric kidney transplant recipients generally have good outcomes post-transplantation. However, the younger age and longer life span after transplantation in the pediatric population make understanding the multifactorial nature of long-term graft survival critical. This investigation analyzes factors associated with 10-year survival to identify areas for improvement in patient care. Kaplan-Meier with log-rank test and univariable and multivariable logistic regression methods were used to retrospectively analyze 7785 kidney transplant recipients under the age of 18 years from January 1, 1998, until March 9, 2008, using United Network for Organ Sharing (UNOS) data. Our end-point was death-censored 10-year graft survival after excluding recipients whose grafts failed within one year of transplant. Recipients aged 5-18 years had lower 10-year graft survival, which worsened as age increased: 5-9 years (OR: 0.66; CI: 0.52-0.83), 10-14 years (OR: 0.43; CI: 0.33-0.55), and 15-18 years (OR: 0.34; CI: 0.26-0.44). Recipient African American ethnicity (OR: 0.67; CI: 0.58-0.78) and Hispanic donor ethnicity (OR: 0.82; CI: 0.72-0.94) had worse outcomes than other donor and recipient ethnicities, as did patients on dialysis at the time of transplant (OR: 0.82; CI: 0.73-0.91). Recipient private insurance status (OR: 1.35; CI: 1.22-1.50) was protective for 10-year graft survival. By establishing the role of age, race, and insurance status on long-term graft survival, we hope to guide clinicians in identifying patients at high risk for graft failure. This study highlights the need for increased allocation of resources and medical care to reduce the disparity in outcomes for certain patient populations.
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Affiliation(s)
- Adrish Anand
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Tahir H Malik
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Jordan Dunson
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Malcolm F McDonald
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | | | - Nhu Thao Nguyen Galvan
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Christine O'Mahony
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - John A Goss
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Poyyapakkam R Srivaths
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Eileen D Brewer
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Abbas Rana
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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13
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Purcell LN, Hayes-Jordan A. Racial and ethnic disparities in access and outcomes in children's health care. Surgery 2021; 169:1288-1289. [PMID: 33676732 DOI: 10.1016/j.surg.2021.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Laura N Purcell
- Department of Surgery, University of North Carolina at Chapel Hill, NC. https://twitter.com/LauraNanka
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14
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Resident foreign patients receive adequate dialysis but fewer preemptive transplantations: data from the Italian pediatric dialysis registry. Pediatr Nephrol 2021; 36:639-647. [PMID: 32914248 DOI: 10.1007/s00467-020-04730-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sociocultural issues play a key role in children needing kidney replacement therapy (KRT). METHODS Data of incident patients < 18 years treated with chronic dialysis or preemptive kidney transplantation (pTx) between 2007 and 2016 were retrospectively collected from the Italian Pediatric Dialysis Registry; KRT modality and outcome were compared between patients with at least one non-Italian parent ("resident foreign patients," RFPs) and those from native parents ("domestic patients," DPs) and between the quinquennium 2007-2011 (period 1) and 2012-2016 (period 2). RESULTS We included 448 children (26.8% RFPs). The percentage of RFPs increased from 23 to 30.3% (p = 0.08) from periods 1 to 2. They were younger (6.7 vs. 9.4 years, p = 0.025) and less often treated with pTx (3.3 vs. 13.4%, p = 0.009) than DPs. The percentage of pTx increased from period 1 to 2 in RFPs only (8.4-18.6%, p = 0.006). Independent predictors of a lower probability of pTx were lower age, belonging to RFPs group, starting KRT in period 1 and focal segmental glomerulosclerosis or glomerulopathy as primary kidney disease. Peritoneal dialysis was the preferred dialysis modality in both groups. Age, primary kidney disease, and center size were independently associated with dialysis modality choice. Patient survival, waiting time to Tx, and dialysis modality survival were not different between the two groups. CONCLUSIONS The proportion of patients receiving KRT born from immigrant families increased in recent years in Italy. They were younger and less often treated with pTx than domestic patients. In case of dialysis, the outcome was not different between the two groups. Graphical abstract.
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15
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Amatya K, Monnin K, Steinberg Christofferson E. Psychological functioning and psychosocial issues in pediatric kidney transplant recipients. Pediatr Transplant 2021; 25:e13842. [PMID: 33012109 DOI: 10.1111/petr.13842] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
Research demonstrates that psychological factors are important for positive transplant outcomes, though there is little literature that synthesizes these factors in a comprehensive model among pediatric kidney transplant patients. This review analyzes psychological and psychosocial factors related to medical outcomes and overall well-being post-transplant by utilizing the PPPHM and referencing the existing literature on risk and resilience. Pediatric kidney transplant recipients are more susceptible to mental health concerns such as depression, anxiety, and ADHD, as well as developmental and neurocognitive delays, compared to healthy peers. Complex medical care and psychosocial needs for patients have implications for family functioning, parental and sibling mental health, and youth readiness to transition to adult care. It is important to carefully monitor patient functioning with empirically validated tools and to intervene in a multidisciplinary setting as early as possible to identify patients at risk and reduce potential negative impact. Psychologists are uniquely trained to assess and address these issues and are a valuable component of multidisciplinary, culturally competent care. While research in this expansive field is improving, more data are needed to establish gold standard approaches to mental health and psychosocial care in this population.
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Affiliation(s)
- Kaushalendra Amatya
- Divisions of Nephrology and Cardiology, Children's National Hospital, Washington, DC, USA.,Pediatrics and Psychiatry & Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kara Monnin
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA
| | - Elizabeth Steinberg Christofferson
- Solid Organ Transplant Surgery, Children's Hospital Colorado, Aurora, CO, USA.,Departments of Psychiatry and Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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16
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Oztek-Celebi FZ, Herle M, Ritschl V, Kaltenegger L, Stamm T, Aufricht C, Boehm M. High Rate of Living Kidney Donation to Immigrant Children Despite Disparities-An Epidemiological Paradox? Front Pediatr 2019; 7:25. [PMID: 30809513 PMCID: PMC6379308 DOI: 10.3389/fped.2019.00025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Kidney transplantation is the preferred treatment modality for children with end-stage renal disease. In the adult population, migration-related modifiable factors were associated with low living donation rates; no such data are available on the pediatric population. This pilot study therefore compares donation modality, communication, knowledge, and attitudes/beliefs between families of immigrant and non-immigrant descent. Methods: Demographic and clinical characteristics of a cohort of children from 77 families of immigrant (32; 42%) and non-immigrant (45; 58%) descent who had undergone renal transplantation were assessed and related to donation modality at the Medical University of Vienna. In a representative subset, modifiable migration-related factors were assessed in a questionnaire-based study. Results: In immigrant families, information delay, limited communication, low knowledge levels, and self-reported conflicting beliefs were significantly more prevalent than in non-immigrants. The living kidney donation rate to children was high in both populations (immigrants: 63%, non-immigrants: 44%; p = 0.12). Living donation to children on dialysis was even significantly higher in immigrant families (immigrants: 13 out of 20; 57%, non-immigrants: 9 out of 33; 27%; p = 0.03). Conclusion: Contrary to expectations, migration-related disparities did not translate into decreased living donation rates in immigrant families, in particular to children on dialysis. Certain factors might therefore be less important for the living donation process in pediatric care structures and/or might be overcome by yet undefined protective factors. Larger pediatric studies including qualitative and quantitative methods are required to validate and refine current conceptual frameworks integrating the perspective of affected families.
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Affiliation(s)
- Fatma Zehra Oztek-Celebi
- Department of Pediatrics and Adolescent Medicine, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey
| | - Marion Herle
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Lukas Kaltenegger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Christoph Aufricht
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Boehm
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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17
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Lim JH, Lee CH, Kim KY, Jung HY, Choi JY, Cho JH, Park SH, Kim YL, Baek MC, Park JB, Kim YH, Chung BH, Lee SH, Kim CD. Novel urinary exosomal biomarkers of acute T cell-mediated rejection in kidney transplant recipients: A cross-sectional study. PLoS One 2018; 13:e0204204. [PMID: 30226858 PMCID: PMC6143249 DOI: 10.1371/journal.pone.0204204] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/05/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Acute rejection is hazardous to graft survival in kidney transplant recipients (KTRs). We aimed to identify novel biomarkers for early diagnosis of acute T cell-mediated rejection (TCMR) in urinary exosomes of KTRs. METHODS Among 458 graft biopsies enrolled in a cross-sectional multicenter study, 22 patients with stable graft function (STA) who had not shown pathologic abnormality and 25 patients who diagnosed biopsy-proven TCMR were analyzed. We performed proteomic analysis using nano-ultra performance liquid chromatography-tandem mass spectrometry (nano-UPLC-MS/MS) to identify candidate biomarkers for early TCMR diagnosis on urinary exosomes. We confirmed the protein levels of each candidate biomarker by western blot analysis. RESULTS A total of 169 urinary exosome proteins were identified by nano-UPLC-MS/MS. Forty-six proteins showed increased expression in STA patients, while 17 proteins were increased in TCMR patients. Among them, we selected five proteins as candidate biomarkers for early diagnosis of TCMR according to significance, degree of quantity variance, and information from the ExoCarta database. We confirmed the proteomic expression levels of five candidate biomarkers by western blot analysis in each patient. Of all candidate biomarkers, tetraspanin-1 and hemopexin were significantly higher in TCMR patients (STA:TCMR ratio = 1:1.8, P = 0.009, and 1:3.5, P = 0.046, respectively). CONCLUSIONS Tetraspanin-1 and hemopexin were detected in KTR urine and could act as potential diagnostic proteins for TCMR.
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Affiliation(s)
- Jeong-Hoon Lim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chan-Hyeong Lee
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kyu Yeun Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji-Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Moon-Chang Baek
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Seoul, South Korea
| | - Young-Hoon Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Inje University, Pusan, South Korea
| | - Byung Ha Chung
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang-Ho Lee
- Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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18
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Green DJ, Brooks MM, Burckart GJ, Chinnock RE, Canter C, Addonizio LJ, Bernstein D, Kirklin JK, Naftel DC, Girnita DM, Zeevi A, Webber SA. The Influence of Race and Common Genetic Variations on Outcomes After Pediatric Heart Transplantation. Am J Transplant 2017; 17:1525-1539. [PMID: 27931092 DOI: 10.1111/ajt.14153] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/16/2016] [Accepted: 11/25/2016] [Indexed: 01/25/2023]
Abstract
Significant racial disparity remains in the incidence of unfavorable outcomes following heart transplantation. We sought to determine which pediatric posttransplantation outcomes differ by race and whether these can be explained by recipient demographic, clinical, and genetic attributes. Data were collected for 80 black and 450 nonblack pediatric recipients transplanted at 1 of 6 centers between 1993 and 2008. Genotyping was performed for 20 candidate genes. Average follow-up was 6.25 years. Unadjusted 5-year rates for death (p = 0.001), graft loss (p = 0.015), acute rejection with severe hemodynamic compromise (p = 0.001), late rejection (p = 0.005), and late rejection with hemodynamic compromise (p = 0.004) were significantly higher among blacks compared with nonblacks. Black recipients were more likely to be older at the time of transplantation (p < 0.001), suffer from cardiomyopathy (p = 0.004), and have public insurance (p < 0.001), and were less likely to undergo induction therapy (p = 0.0039). In multivariate regression models adjusting for age, sex, cardiac diagnosis, insurance status, and genetic variations, black race remained a significant risk factor for all the above outcomes. These clinical and genetic variables explained only 8-19% of the excess risk observed for black recipients. We have confirmed racial differences in survival, graft loss, and several rejection outcomes following heart transplantation in children, which could not be fully explained by differences in recipient attributes.
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Affiliation(s)
- D J Green
- Pediatric Clinical Pharmacology Staff, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD
| | - M M Brooks
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - G J Burckart
- Pediatric Clinical Pharmacology Staff, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD
| | - R E Chinnock
- Department of Pediatrics, Loma Linda University, Loma Linda, CA
| | - C Canter
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO
| | - L J Addonizio
- Division of Cardiology, Department of Pediatrics, Columbia University, New York, NY
| | - D Bernstein
- Division of Cardiology, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA
| | - J K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - D C Naftel
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - D M Girnita
- Department of Pathology, Thomas E Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA
| | - A Zeevi
- Department of Pathology, Thomas E Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA
| | - S A Webber
- Department of Pediatrics, Vanderbilt University, Nashville, TN
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19
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Ambulatory Blood Pressure, Left Ventricular Hypertrophy, and Allograft Function in Children and Young Adults After Kidney Transplantation. Transplantation 2017; 101:150-156. [PMID: 26895218 DOI: 10.1097/tp.0000000000001087] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hypertension is a common complication and is an important risk factor for graft loss and adverse cardiovascular outcomes in pediatric kidney transplantation. Ambulatory blood pressure monitoring (ABPM) is the preferred method to characterize blood pressure status. METHODS We conducted a retrospective review of a large cohort of children and young adults with kidney transplant to estimate the prevalence of abnormal ambulatory blood pressure (ABP), assess factors associated with abnormal ABP, and examine whether ambulatory hypertension is associated with worse allograft function and left ventricular hypertrophy (LVH). RESULTS Two hundred twenty-one patients had ABPM, and 142 patients had echocardiographic results available for analysis. One third of the patients had masked hypertension, 32% had LVH, and 38% had estimated glomerular filtration rate less than 60 mL/min per 1.73 m. African-American race/Hispanic ethnicity and requirement for more than 1 antihypertensive medication were independently associated with having masked hypertension. In a multivariate analysis, abnormal blood pressure (masked or sustained hypertension combined) was an independent predictor for LVH among patients not receiving antihypertensive treatment (P = 0.025). In a separate analysis, the use of antihypertensive medications was independently associated with worse allograft function (P = 0.002) although abnormal blood pressure was not a significant predictor. CONCLUSIONS In young kidney transplant recipients, elevated ABP is frequently unrecognized and undertreated. The high prevalence of abnormal ABP, including masked hypertension, and its association with LVH supports the case for routine ABPM and cardiac structure evaluation as the standard of care in these patients.
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20
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Crowson CN, Reed RD, Shelton BA, MacLennan PA, Locke JE. Lymphocyte-depleting induction therapy lowers the risk of acute rejection in African American pediatric kidney transplant recipients. Pediatr Transplant 2017; 21. [PMID: 27699934 DOI: 10.1111/petr.12823] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
Abstract
The use of lymphocyte-depleting induction immunosuppression has been associated with a reduction in risk of AR after KT among adult recipients, particularly among high-risk subgroups such as AAs. However, data on induction regimen and AR risk are lacking among pediatric KT recipients. We examined outcomes among 7884 first-time pediatric KT recipients using SRTR data (2000-2014). Characteristics were compared across race using Wilcoxon rank-sum tests for continuous and chi-square tests for categorical variables. Risk of AR was estimated using modified Poisson regression, stratified by recipient race, adjusting for recipient age, gender, BMI, primary diagnosis, number of HLA mismatches, maintenance immunosuppression, and donor type. Risk of AR within 1 year was lower in AA recipients receiving lymphocyte-depleting induction (ATG or alemtuzumab; RR, 0.66; 95% CI, 0.52-0.83 P < .001) compared to AA recipients receiving anti-IL-2 receptor antibody induction. This difference was not seen in non-AA recipients receiving lymphocyte-depleting induction (RR, 0.93; 95% CI, 0.81-1.06, P = .26) compared to IL-2 induction. These findings support a role for lymphocyte-depleting induction agents in AA pediatric patients undergoing KT and continued use of IL-2 inhibitor induction in non-AA pediatric KT recipients.
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Affiliation(s)
- Cole N Crowson
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brittany A Shelton
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul A MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jayme E Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
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21
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Guan I, Singer P, Frank R, Chorny N, Infante L, Sethna CB. Role of race in kidney transplant outcomes in children with focal segmental glomerulosclerosis. Pediatr Transplant 2016; 20:790-7. [PMID: 27460535 DOI: 10.1111/petr.12766] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/30/2022]
Abstract
It is well established that racial differences exist in kidney transplant outcomes; however, there are no studies which focus on the role of race in transplant outcomes specifically in children diagnosed with FSGS. Associations between race and transplant outcomes in FSGS children were evaluated using the Organ Procurement and Transplantation Network database from 2000 to 2012. Recipients aged 2-21 years who received a kidney-only transplant were included. Multivariate regression models were used to evaluate transplant outcomes by race. Five hundred and thirty-six recipients (59.7% male, 15.6±3.9 years) were black and 1134 (55.7% male, 14.3±5.0 years) were non-black. Graft survival was significantly shorter in the black group (4.2±3.1 vs 4.6±3.3 years, P=.005). Black race was associated with significantly higher risk of graft failure (HR 1.34, 95% CI=1.21-1.49, P<.0001), acute rejection (OR 1.66 95% CI=1.39-1.97, P<.0001), and delayed graft function (OR 1.51, 95% CI=1.33-1.72, P<.001) compared to non-black race. There were no significant differences in mortality, prolonged hospitalization, or FSGS recurrence between groups. Race is a significant predictor for worse transplant outcomes in children with FSGS.
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Affiliation(s)
- Ivan Guan
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Pamela Singer
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Rachel Frank
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Nataliya Chorny
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Lulette Infante
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Christine B Sethna
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
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22
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Michael M, Minard CG, Kale AS, Brewer ED. Outcomes of two-drug maintenance immunosuppression for pediatric renal transplantation: 10-yr follow-up in a single center. Pediatr Transplant 2016; 20:49-58. [PMID: 26916966 DOI: 10.1111/petr.12627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 11/30/2022]
Abstract
Minimizing IS to reduce side effects without compromising long-term renal transplant survival is the goal of all IS protocols. We conducted a retrospective study of pediatric renal transplants performed August 1988 to July 2008 and treated with two-drug maintenance therapy by one of three protocols: prednisone/cyclosporine without induction (SB) or with daclizumab induction (SBI), or tacrolimus/mycophenolate with daclizumab induction (SF). Kaplan-Meier survival curves were used to determine graft and patient survival at one, three, five, and 10 yr. Associations between graft survival and patient/transplant characteristics were determined using log-rank test and CPH model adjusting for treatment group. About 208 patients were included in the analysis (96 SB, 97 SBI, 15 SF; 148 DD, 60 LD, 37 pre-emptive). Overall graft and patient survival at one, three, five, and 10 yr were similar to the previously published results of pediatric renal transplants in similar years treated predominantly with three-drug maintenance therapy (https://web.emmes.com/study/ped/annlrept/2010). Only biopsy-proven TG was significantly associated with worse graft survival (HR 11.5, 95% CI: 3.4, 38.7). Malignancy rate was low (2.4%) with little PTLD (0.5%). Few opportunistic or other infections occurred (<5% patients). Minimizing IS to a two-drug maintenance regimen had no adverse effect on long-term transplant outcome and had low malignancy and infection rates.
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Affiliation(s)
- Mini Michael
- Renal Section, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Arundhati S Kale
- Renal Section, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Eileen D Brewer
- Renal Section, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Tjaden LA, Noordzij M, van Stralen KJ, Kuehni CE, Raes A, Cornelissen EA, O’Brien C, Papachristou F, Schaefer F, Groothoff JW, Jager KJ. Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association−European Dialysis and Transplant Association) Registry. Am J Kidney Dis 2016; 67:293-301. [DOI: 10.1053/j.ajkd.2015.09.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/19/2015] [Indexed: 11/11/2022]
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24
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An overview of disparities and interventions in pediatric kidney transplantation worldwide. Pediatr Nephrol 2015; 30:1077-86. [PMID: 25315177 PMCID: PMC4398585 DOI: 10.1007/s00467-014-2879-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 01/14/2023]
Abstract
Despite the stated goals of the transplant community and the majority of organ allocation systems, persistent racial disparities in pediatric kidney transplantation exist throughout the world. These disparities are evident in both living and deceased donor kidney transplantation and are independent of any clinical differences between racial groups. The reasons for these persistent disparities are multifactorial, reflecting both patient and provider barriers to care. In this review, we examine the most current findings regarding disparities in pediatric kidney transplantation and consider interventions which may help reduce those disparities.
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Grace BS, Kara T, Kennedy SE, McDonald SP. Racial disparities in pediatric kidney transplantation in New Zealand. Pediatr Transplant 2014; 18:689-97. [PMID: 25039826 DOI: 10.1111/petr.12322] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 12/01/2022]
Abstract
Racial disparities in transplantation rates and outcomes have not been investigated in detail for NZ, a country with unique demographics. We studied a retrospective cohort of 215 patients <18 yr who started renal replacement therapy in NZ 1990-2012, using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Primary outcomes were time to first kidney transplant, death-censored graft survival, and retransplantation after loss of primary graft. Europeans and Asians were most likely to receive a transplant (92% and 91% transplanted within five yr, respectively), and Pacific and Māori patients were less likely to receive a transplant than Europeans (51% and 46%, respectively), reflecting disparities in live donor transplantation. Pacific patients were more likely to have glomerulonephritis and FSGS. Pacific patients had five-yr death-censored graft survival of 31%, lower than Māori (61%) and Europeans (88%). No Pacific patients who lost their grafts were re-transplanted within 72 patient-years of follow-up, whereas 14% of Māori patients and 36% of European and Asian patients were retransplanted within five yr. Current programs to improve live and deceased donation within Māori and Pacific people and management of recurrent kidney disease are likely to reduce these disparities.
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Affiliation(s)
- Blair S Grace
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, SA, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
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Racial and ethnic disparities in pediatric renal allograft survival in the United States. Kidney Int 2014; 87:584-92. [PMID: 25337773 PMCID: PMC4344895 DOI: 10.1038/ki.2014.345] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 07/25/2014] [Accepted: 08/14/2014] [Indexed: 12/12/2022]
Abstract
This study was undertaken to describe the association of patient race/ethnicity and renal allograft survival among the national cohort of pediatric renal allograft recipients. Additionally, we determined whether racial and ethnic differences in graft survival exist among individuals living in low or high poverty neighborhoods and those with private or public insurance. Among 6,216 incident, pediatric End Stage Renal Disease patients in the United States Renal Data System (kidney transplant from 2000 through September, 2011) 14.4% experienced graft failure, with a median follow-up time of 4.5 years. After controlling for multiple covariates, black race, but not Hispanic ethnicity, was significantly associated with a higher rate of graft failure for both deceased and living donor transplant recipients. Disparities were particularly stark by 5 years post-transplant, when black living donor transplant recipients experienced only 63.0% graft survival compared with 82.8% and 80.8% for Hispanics and whites, respectively. These disparities persisted among high and low poverty neighborhoods and among both privately- and publicly-insured patients. Notably profound declines in both deceased and living donor graft survival rates for black, compared to white and Hispanic, children preceded the 3-year mark when transplant Medicare eligibility ends. Further research is needed to identify the unique barriers to long-term graft success among black pediatric transplant recipients.
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Abstract
PURPOSE OF REVIEW Kidney transplantation remains the optimal treatment for children with end-stage renal disease; yet, in the United States, profound differences in access to transplant persist, with black children experiencing significantly reduced access to transplant compared with white children. The reasons for these disparities remain poorly understood. Several recent studies provide new insights into the interplay of socioeconomic status, racial/ethnic disparities and access to pediatric kidney transplantation. RECENT FINDINGS New evidence suggests that disparities are more pronounced in access to living vs. deceased donors. National allocation policies have mitigated racial differences in pediatric deceased donor kidney transplant (DDKT) access after waitlisting. However, disparities in access to DDKT are stark for minority emerging adults, who lose pediatric priority allocation. Although absence of health insurance poses an important barrier to transplant, even after adjustment for insurance status and neighborhood poverty, disparities persist. Differential access to care and unjust social structures are posited as important modifiable barriers to achieving equity in pediatric transplant access. SUMMARY Future approaches to overcome disparities in pediatric kidney transplant access must focus on the continuum of the transplant process, including equitable health care access. Public health advocacy efforts to promote national policies that address disparate multilevel socioeconomic factors are essential.
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Organ transplantation and donation: why minority groups need more organs but donate less-it's complex! Crit Care Med 2014; 42:1546-8. [PMID: 24836790 DOI: 10.1097/ccm.0000000000000264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Van Arendonk KJ, Boyarsky BJ, Orandi BJ, James NT, Smith JM, Colombani PM, Segev DL. National trends over 25 years in pediatric kidney transplant outcomes. Pediatrics 2014; 133:594-601. [PMID: 24616363 PMCID: PMC4530294 DOI: 10.1542/peds.2013-2775] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate changes in pediatric kidney transplant outcomes over time and potential variations in these changes between the early and late posttransplant periods and across subgroups based on recipient, donor, and transplant characteristics. METHODS Using multiple logistic regression and multivariable Cox models, graft and patient outcomes were analyzed in 17,446 pediatric kidney-only transplants performed in the United States between 1987 and 2012. RESULTS Ten-year patient and graft survival rates were 90.5% and 60.2%, respectively, after transplantation in 2001, compared with 77.6% and 46.8% after transplantation in 1987. Primary nonfunction and delayed graft function occurred in 3.3% and 5.3%, respectively, of transplants performed in 2011, compared with 15.4% and 19.7% of those performed in 1987. Adjusted for recipient, donor, and transplant characteristics, these improvements corresponded to a 5% decreased hazard of graft loss, 5% decreased hazard of death, 10% decreased odds of primary nonfunction, and 5% decreased odds of delayed graft function with each more recent year of transplantation. Graft survival improvements were lower in adolescent and female recipients, those receiving pretransplant dialysis, and those with focal segmental glomerulosclerosis. Patient survival improvements were higher in those with elevated peak panel reactive antibody. Both patient and graft survival improvements were most pronounced in the first posttransplant year. CONCLUSIONS Outcomes after pediatric kidney transplantation have improved dramatically over time for all recipient subgroups, especially for highly sensitized recipients. Most improvement in graft and patient survival has come in the first year after transplantation, highlighting the need for continued progress in long-term outcomes.
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Affiliation(s)
- Kyle J. Van Arendonk
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian J. Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Babak J. Orandi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan T. James
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jodi M. Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; and
| | - Paul M. Colombani
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;,Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
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Phelan PJ, Conlon PJ, Sparks MA. Genetic determinants of renal transplant outcome: where do we stand? J Nephrol 2014; 27:247-56. [DOI: 10.1007/s40620-014-0053-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/05/2013] [Indexed: 01/07/2023]
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Farrugia D, Cheshire J, Mahboob S, Begaj I, Khosla S, Ray D, Sharif A. Mortality after pediatric kidney transplantation in England--a population-based cohort study. Pediatr Transplant 2014; 18:16-22. [PMID: 24134627 DOI: 10.1111/petr.12173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/27/2022]
Abstract
The aim of this study was to explore mortality after pediatric kidney transplantation in England over the last decade. We used data from HES to select all kidney transplant procedures performed in England between April 2001 and March 2012. Data linkage analysis was performed with the ONS to identify all deaths occurring among this study cohort. Data for 1189 pediatric recipients were compared to 17 914 adult recipients (number of deaths, 33 vs. 2052, respectively, p < 0.001), with median follow-up 4.4 yr (interquartile range 2.2-7.3 yr). There was no difference in mortality within the pediatric cohort; age 0-1 (n = 25, patient survival 100.0%), age 2-5 (n = 198, patient survival 96.0%), age 6-12 (n = 359, patient survival 97.5%), and age 13-18 (n = 607, patient survival 97.4%), respectively (p = 0.567). The most common causes of death were renal (n = 8, 24.2%), infection (n = 6, 18.2%), and malignancy (n = 5, 15.2%). All deaths from malignancy were secondary to PTLD. In a fully adjusted Cox regression model, only white ethnicity was significantly associated with risk of pediatric mortality post-kidney transplantation (hazard ratio 2.7, 95% confidence interval [1.0-7.3], p = 0.047). To conclude, this population-based cohort study confirms low mortality after pediatric kidney transplantation with short follow-up.
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Affiliation(s)
- Daniela Farrugia
- Department of Nephrology and Transplantation, Renal Institute of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
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Narayanan M, Pankewycz O, Shihab F, Wiland A, McCague K, Chan L. Long-term outcomes in African American kidney transplant recipients under contemporary immunosuppression: a four-yr analysis of the Mycophenolic acid Observational REnal transplant (MORE) study. Clin Transplant 2013; 28:184-91. [PMID: 24372743 DOI: 10.1111/ctr.12294] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 12/01/2022]
Abstract
Mycophenolic acid Observational REnal transplant (MORE) was a prospective, observational study of de novo kidney transplant patients receiving mycophenolic acid (MPA). Four-yr data on 904 patients receiving tacrolimus and enteric-coated mycophenolate sodium (EC-MPS) or mycophenolate mofetil (MMF) were analyzed to evaluate immunosuppression and graft outcomes in African American (AA, n = 218) vs. non-AA (n = 686) patients. Mean tacrolimus dose was higher in AA vs. non-AA patients but mean tacrolimus trough concentration was similar. Use of the recommended MPA dose in AA patients decreased from 78.9% at baseline to 33.1% at year 3. More AA patients received the recommended MPA dose with EC-MPS than MMF at month 6 (56.2% vs. 35.7%, p = 0.016) and month 36 (46.6% vs. 16.7%, p = 0.029), with no safety penalty. Significantly, more AA patients received corticosteroids than non-AA patients. Biopsy-proven acute rejection was higher in AA vs. non-AA patients (18.9% vs. 10.7%, p = 0.003), as was graft loss (10.9% vs. 4.4%, p = 0.003); differences were confirmed by Cox regression analysis. Patient survival was similar. Estimated GFR was comparable in AA vs. non-AA patients. Kidney allograft survival remains lower for AA vs. non-AA recipients even under the current standard of care.
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Donor and recipient size mismatch in adolescents undergoing living-donor renal transplantation affect long-term graft survival. Transplantation 2013; 96:555-9. [PMID: 23838999 DOI: 10.1097/tp.0b013e31829d672c] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Controversies exist in the adult literature regarding the use of kidneys from small donors into larger recipients. Little is known regarding this issue in pediatric kidney transplantation. To assess the impact of donor/recipient size mismatch on long-term renal graft survival in pediatric patients undergoing living-donor renal transplantation. METHODS We reviewed the United Network for Organ Sharing database from 1987 to 2010 for adolescent (11-18 years old) patients who underwent primary living-donor renal transplantation. According to donor/recipient body surface area (BSA) ratio, patients were stratified into two categories: BSA ratio <0.9 and ≥0.9. Graft survival rates were compared between these two groups using Kaplan-Meier survival curves and Cox proportional hazards models. RESULTS Of the 1880 patients identified, 116 (6.2%) had a donor/recipient BSA ratio <0.9 and 1764 (93.8%) had a donor/recipient BSA ratio ≥0.9 group. BSA ratio <0.9 conferred an increased risk of graft loss (adjusted hazard ratio, 1.61; 95% confidence interval, 1.13-2.27; P=0.008). Patients with a donor/recipient BSA ratio ≥0.9 group had a significantly longer graft survival compared with those with a donor/recipient BSA ratio <0.9 after adjustment for donor age and gender, recipient age, gender, ethnicity, cause of renal failure, as well as clinical factors, such as cold and warm ischemia time and HLA mismatch. CONCLUSION We conclude that low donor/recipient BSA ratio was associated with an increased risk of graft loss. Appropriate size matching conferred better long-term graft survival in adolescents receiving live-donor kidney transplants.
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Stone ML, LaPar DJ, Kane BJ, Rasmussen SK, McGahren ED, Rodgers BM. The effect of race and gender on pediatric surgical outcomes within the United States. J Pediatr Surg 2013; 48:1650-6. [PMID: 23932602 PMCID: PMC4219564 DOI: 10.1016/j.jpedsurg.2013.01.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 01/28/2013] [Accepted: 01/28/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to examine risk-adjusted associations between race and gender on postoperative morbidity, mortality, and resource utilization in pediatric surgical patients within the United States. METHODS 101,083 pediatric surgical patients were evaluated using the U.S. national KID Inpatient Database (2003 and 2006): appendectomy (81.2%), pyloromyotomy (9.8%), intussusception (6.2%), decortication (1.9%), congenital diaphragmatic hernia repair (0.7%), and colonic resection for Hirschsprung's disease (0.2%). Patients were stratified according to gender (male: 63.1%, n=63,783) and race: white (n=58,711), Hispanic (n=26,118), black (n=9,103), Asian (n=1,582), Native American (n=474), and other (n=5,096). Multivariable logistic regression modeling was utilized to evaluate risk-adjusted associations between race, gender, and outcomes. RESULTS After risk adjustment, race was independently associated with in-hospital death (p=0.02), with an increased risk for black children. Gender was not associated with mortality (p=0.77). Postoperative morbidity was significantly associated with gender (p<0.001) and race (p=0.01). Gender (p=0.003) and race (p<0.001) were further associated with increased hospital length of stay. Importantly, these results were dependent on operation type. CONCLUSION Race and gender significantly affect postoperative outcomes following pediatric surgery. Black patients are at disproportionate risk for postoperative mortality, while black and Hispanic patients have increased morbidity and hospital resource utilization. While gender does not affect mortality, gender is a determinant of both postoperative morbidity and increased resource utilization.
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Affiliation(s)
- Matthew L. Stone
- Department of Surgery, The University of Virginia, Charlottesville, Virginia, USA
| | - Damien J. LaPar
- Department of Surgery, The University of Virginia, Charlottesville, Virginia, USA
| | - Bartholomew J. Kane
- Division of Pediatric Surgery, The University of Virginia, Charlottesville, Virginia, USA
| | - Sara K. Rasmussen
- Division of Pediatric Surgery, The University of Virginia, Charlottesville, Virginia, USA
| | - Eugene D. McGahren
- Division of Pediatric Surgery, The University of Virginia, Charlottesville, Virginia, USA
| | - Bradley M. Rodgers
- Division of Pediatric Surgery, The University of Virginia, Charlottesville, Virginia, USA
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Smith JM, Martz K, Blydt-Hansen TD. Pediatric kidney transplant practice patterns and outcome benchmarks, 1987-2010: a report of the North American Pediatric Renal Trials and Collaborative Studies. Pediatr Transplant 2013; 17:149-57. [PMID: 23281637 DOI: 10.1111/petr.12034] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/30/2022]
Abstract
The NAPRTCS transplant registry has collected clinical information on children undergoing kidney transplantation since 1987 and now includes information on 11 603 kidney transplants in 10 632 patients. Since the first data analysis in 1989, NAPRTCS reports have documented marked improvements in outcome after kidney transplantation in addition to identifying factors associated with both favorable and poor outcomes. Patient demographics have changed over the course of the registry with a decrease in the percentage of white recipients from a high of 72% in 1987 to less than 43% in 2007. The percentage of living donors decreased to its lowest point in 2007 at 37%. Acute rejection rates continue to decline with improvements in short- and long-term graft survival. Recently, NAPRTCS data have been used as a source of benchmark data for pediatric kidney transplant centers.
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Affiliation(s)
- Jodi M Smith
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA.
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36
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Narayanan M, Pankewycz O, El-Ghoroury M, Shihab F, Wiland A, McCague K, Chan L. Outcomes in African American Kidney Transplant Patients Receiving Tacrolimus and Mycophenolic Acid Immunosuppression. Transplantation 2013; 95:566-72. [DOI: 10.1097/tp.0b013e318277438f] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Amaral S, Patzer RE, Kutner N, McClellan W. Racial disparities in access to pediatric kidney transplantation since share 35. J Am Soc Nephrol 2012; 23:1069-77. [PMID: 22539831 DOI: 10.1681/asn.2011121145] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Share 35 was enacted in 2005 to shorten transplant wait times and provide high-quality donors to children with ESRD. To investigate the possible effect of this policy on racial disparities in access to pediatric transplantation, we analyzed data from the US Renal Data System before and after Share 35. Among 4766 pediatric patients with incident ESRD, the probability of receiving a deceased-donor kidney transplant increased 46% after Share 35, with Hispanics experiencing the greatest improvements (increases of 81% for Hispanics, 45% for blacks, and 37% for whites). On average, patients received a deceased-donor kidney transplant earlier after Share 35, but this finding varied by race: 63 days earlier for whites, 90 days earlier for blacks, and 201 days earlier for Hispanics. Furthermore, a shift from living- to deceased-donor sources occurred with Share 35 for all races, with a 25% reduction in living donors for whites compared with 48% and 46% reductions for Hispanics and blacks, respectively. In summary, Share 35 seems to have attenuated racial disparities in the time to and probability of children receiving a deceased-donor kidney transplant. These changes coincided with changes in the rates of living-donor sources, which vary by race. Future studies should explore how these changes may impact racial differences in long-term graft outcomes.
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Affiliation(s)
- Sandra Amaral
- Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Patzer RE, Amaral S, Klein M, Kutner N, Perryman JP, Gazmararian JA, McClellan WM. Racial disparities in pediatric access to kidney transplantation: does socioeconomic status play a role? Am J Transplant 2012; 12:369-78. [PMID: 22226039 PMCID: PMC3951009 DOI: 10.1111/j.1600-6143.2011.03888.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Racial disparities persist in access to renal transplantation in the United States, but the degree to which patient and neighborhood socioeconomic status (SES) impacts racial disparities in deceased donor renal transplantation access has not been examined in the pediatric and adolescent end-stage renal disease (ESRD) population. We examined the interplay of race and SES in a population-based cohort of all incident pediatric ESRD patients <21 years from the United States Renal Data System from 2000 to 2008, followed through September 2009. Of 8452 patients included, 30.8% were black, 27.6% white-Hispanic, 44.3% female and 28.0% lived in poor neighborhoods. A total of 63.4% of the study population was placed on the waiting list and 32.5% received a deceased donor transplant. Racial disparities persisted in transplant even after adjustment for SES, where minorities were less likely to receive a transplant compared to whites, and this disparity was more pronounced among patients 18-20 years. Disparities in access to the waiting list were mitigated in Hispanic patients with private health insurance. Our study suggests that racial disparities in transplant access worsen as pediatric patients transition into young adulthood, and that SES does not explain all of the racial differences in access to kidney transplantation.
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Affiliation(s)
- R. E. Patzer
- Department of Surgery, Emory Transplant Center, Emory University School of Medicine, Atlanta, GA,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA,Corresponding author: Rachel E. Patzer,
| | - S. Amaral
- Renal Division, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - M. Klein
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - N. Kutner
- Rehabilitation Medicine, Emory University, Atlanta, GA
| | | | - J. A. Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - W. M. McClellan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA,Renal Division, Emory University, Atlanta, GA
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Pediatric renal transplantation in the jordanian population: the clinical outcome measures during long-term follow-up period. Pediatr Neonatol 2012; 53:24-33. [PMID: 22348491 DOI: 10.1016/j.pedneo.2011.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 01/13/2011] [Accepted: 01/21/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Recently, many international studies have suggested that pediatric patients from diverse ethnic origins confront unique challenges for transplantation. Data concerning the efficacy and safety of transplantation for various pediatric renal transplant populations remains limited and are often confounded by immunosuppressive protocols. In one study, we aimed to evaluate the short- and long-term outcomes of renal transplants in Jordanian children in comparison with groups of different nationalities. METHODS We retrospectively retrieved data for 34 Jordanian children who received kidney transplants from living donors between January 2003 and January 2009. Subsequently, we continued to follow-up with these selected patients at scheduled clinic visits to prospectively collect long-term data for a period of approximately 22 months±15 months. RESULTS The patients included in this study ranged between 4 years and 19 years of age. The male/female ratio was 0.79. Glumerulonephritis (35.3%) was the most common cause of end-stage renal disease in the sample of this study; 23.5% had received a preemptive transplant. All patients also received triple immunosuppressive therapy, consisting of tacrolimus (TAC), prednisolone, and mycophenolate mofetil (n=26) or azathioprine (n=8). Furthermore, the rate of acute rejection episodes was lower in the sample of this study than the average rate of many previous studies. The patients' survival rate at 1 year, 2 years and 3 years posttransplant was nearly 100%. The corresponding graft survivals were 97.1%, 94.12% and 91.2% respectively. Beyond three years, one female patient died postgraft loss. This graft loss was mainly attributed to recurrent glomerulonephritis. Strikingly, the prevalence of posttransplant diabetes (PTD) and hypertension was higher than reported international figures. Other adverse events, such as infections, were manageable. CONCLUSION The average result of pediatric renal transplantation in Jordan is more successful than the average results of this procedure in many developed countries, especially in terms of early graft function, acute rejection episodes as well as long-term patient and graft survivals. However, additional studies are needed to better characterize pharmacokinetic of TAC and to fully understand those factors that lead to an increased probability of developing conditions like PTD and hypertension.
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Foster BJ, Dahhou M, Zhang X, Platt RW, Samuel SM, Hanley JA. Association Between Age and Graft Failure Rates in Young Kidney Transplant Recipients. Transplantation 2011; 92:1237-43. [DOI: 10.1097/tp.0b013e31823411d7] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Foster BJ, Platt RW, Dahhou M, Zhang X, Bell LE, Hanley JA. The impact of age at transfer from pediatric to adult-oriented care on renal allograft survival. Pediatr Transplant 2011; 15:750-9. [PMID: 21883752 DOI: 10.1111/j.1399-3046.2011.01567.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immaturity among individuals transferred from pediatric to adult-oriented care at a young age may leave them vulnerable to higher graft failure risks than in individuals transferred older. We sought to determine the impact of age at transfer on renal allograft failure rates. We evaluated graft failure rates among 440 kidney recipients recorded in the UNOS database (1987-2007), who had been transferred from pediatric to adult care. Transfers were identified using the center codes recorded at yearly data collection. Failure rates for those transferred early (<21 yr old) were compared with rates for those transferred late (≥21 yr old); time-dependent Cox models were used to estimate the additional risk of graft failure associated with early vs. late transfer. The age-standardized failure rate was 12.9 per 100 person-years among those transferred early, and 8.7 per 100 person-years among those transferred late. Compared with individuals the same age who had transferred late, graft failure rates were 58% higher ([95% confidence interval: 7%, 134%], p = 0.02) among those who had transferred early. Younger age at transfer to adult care is associated with higher graft failure rates. Transfer to adult-oriented care at <21 yr of age should be undertaken with caution.
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Affiliation(s)
- Bethany J Foster
- Department of Pediatrics, Division of Nephrology, McGill University Faculty of Medicine, Montreal, QC, Canada.
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Abstract
Kidney transplantation is the treatment of choice for the majority of pediatric patients with end-stage kidney disease. Previous studies demonstrating racial or gender disparities in access to the deceased donor transplant list could not evaluate the impact of medical concerns or patient preference on waitlist status. We undertook a retrospective cohort study using the NAPRTCS registry to begin to determine barriers to wait list registration for kidney transplantation among pediatric dialysis patients. Clinical and demographic factors were compared in listed vs. non-listed patients. Reasons cited for not listing patients were examined by clinical and demographic factors. At dialysis initiation, 88.7% of pediatric dialysis patients were not on the renal transplant wait list. Twelve months after dialysis initiation, 67.1% of pediatric dialysis patients were not on the wait list. The groups least likely to be on the wait list were infants (adjusted OR 0.23, 95% CI 0.16, 0.32) and girls (adjusted OR 0.78, 95% CI 0.67, 0.90) after adjusting for multiple confounders. The reason most often cited for not listing was medical reason for young infants and that the transplant workup was pending for girls. Further study is needed to identify barriers to wait list registration.
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Rheault MN, Chavers BM. Achieving racial parity in pediatric kidney transplantation: yes we can. Pediatr Transplant 2010; 14:807-8. [PMID: 20849491 DOI: 10.1111/j.1399-3046.2010.01372.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Singh TP, Naftel DC, Addonizio L, Mahle W, Foushee MT, Zangwill S, Blume ED, Kirklin JK, Singh R, Johnston JK, Chinnock R. Association of race and socioeconomic position with outcomes in pediatric heart transplant recipients. Am J Transplant 2010; 10:2116-23. [PMID: 20883546 DOI: 10.1111/j.1600-6143.2010.03241.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We assessed the association of socioeconomic (SE) position with graft loss in a multicenter cohort of pediatric heart transplant (HT) recipients. We extracted six SE variables from the US Census 2000 database for the neighborhood of residence of 490 children who underwent their primary HT at participating transplant centers. A composite SE score was derived for each child and four groups (quartiles) compared for graft loss (death or retransplant). Graft loss occurred in 152 children (122 deaths, 30 retransplant). In adjusted analysis, graft loss during the first posttransplant year had a borderline association with the highest SE quartile (HR 1.94, p = 0.05) but not with race. Among 1-year survivors, both black race (HR 1.81, p = 0.02) and the lowest SE quartile (HR 1.77, p = 0.01) predicted subsequent graft loss in adjusted analysis. Among subgroups, the lowest SE quartile was associated with graft loss in white but not in black children. Thus, we found a complex relationship between SE position and graft loss in pediatric HT recipients. The finding of increased risk in the highest SE quartile children during the first year requires further confirmation. Black children and low SE position white children are at increased risk of graft loss after the first year.
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Affiliation(s)
- T P Singh
- Department of Cardiology, Children's Hospital Boston, MA, USA.
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Moudgil A, Martz K, Stablein DM, Puliyanda DP. Variables affecting estimated glomerular filtration rate after renal transplantation in children: a NAPRTCS data analysis. Pediatr Transplant 2010; 14:288-94. [PMID: 19686443 DOI: 10.1111/j.1399-3046.2009.01222.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Short-term graft survival has improved in renal transplants without significant effect on long-term graft survival. As GFR decline precedes graft loss, an understanding of variables affecting eGFR after TX may help improve graft survival. NAPRTCS data were analyzed to assess effects of donor, recipient, and other variables on Schwartz eGFR after transplantation. For 8438 children with a functioning graft at day 30, data were censored for children dying with a functioning graft, and those with <3 yr follow-up. Multivariate linear regression and repeated measures analyses identified factors related to eGFR at day 30 after TX and during follow-up. Young, female, non-black, children without ATN and acute rejection in the first 30 days, TX after 1995, those with better eGFR at day 30, and receiving tacrolimus had better long-term eGFR. Transplant from ideal (6-35 yr) donors had best short-term eGFR, young donors (<5 yr) had lower eGFR and poor graft survival. After one yr, eGFR improved in surviving grafts of young donors and matched ideal donors. Acute rejection, BP medications, and hospitalizations in prior six months had negative association with subsequent eGFR. Regardless of variables, eGFR deteriorated with time. Slope of eGFR decline has not changed in the recent era indicating the need for innovative therapies.
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Affiliation(s)
- A Moudgil
- Nephrology, Children National Medical Center, Washington, DC 20010, USA.
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Matsuda-Abedini M, Al-AlSheikh K, Hurley RM, Matsell DG, Chow J, Carter JE, Lirenman DS. Outcome of kidney transplantation in Canadian Aboriginal children in the province of British Columbia. Pediatr Transplant 2009; 13:856-60. [PMID: 19067910 DOI: 10.1111/j.1399-3046.2008.01074.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Renal transplantation remains the therapy of choice for children and adolescents with ESRD. Differences in graft survival are observed in kidney transplant recipients of different race and ethnicities. Data in pediatric populations are limited and confounded by disparities in access to health care. We performed a retrospective single Canadian centre database review to determine the short- and long-term outcomes of kidney transplantation in Aboriginal children compared to non-Aboriginals. A total of 159 primary renal transplant recipients at BCCH between 1985 and 2005 were examined (15% Aboriginal). Aboriginal children had different etiologies of ESRD, and a higher percentage of females, but were similar in age at transplantation, cold ischemia time and living donation rate. Early graft outcomes such as delayed graft function, episodes of acute rejection in the first year post-transplant and estimated glomerular function rate at one yr were similar in both groups. Long-term graft survival, however, was significantly worse in the Aboriginal group, with a significantly increased rate of late rejections: 50% compared with 26.7% among non-Aboriginals (p = 0.03). In a province with uniform access to health care, significant differences in long-term graft outcome exist among Aboriginal children compared with non-Aboriginals.
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Affiliation(s)
- Mina Matsuda-Abedini
- Department of Pediatrics, Division of Nephrology, British Columbia's Children's Hospital, British Columbia, Canada.
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Black renal transplant recipients have poorer long-term graft survival than CYP3A5 expressers from other ethnic groups. Nephrol Dial Transplant 2009; 25:628-34. [DOI: 10.1093/ndt/gfp530] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Singh TP, Gauvreau K, Bastardi HJ, Blume ED, Mayer JE. Socioeconomic position and graft failure in pediatric heart transplant recipients. Circ Heart Fail 2009; 2:160-5. [PMID: 19808335 DOI: 10.1161/circheartfailure.108.800755] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Socioeconomic (SE) position may affect availability of resources, health-related behavior, and outcomes. We assessed whether patient SE position, determined for the block group of patient residence (average population 1000, smallest census unit with SE data), is associated with graft failure in pediatric heart transplant recipients. METHODS AND RESULTS We used the US Census 2000 database to derive a composite SE score for the block group of residence for all patients who underwent their first heart transplant at Children's Hospital Boston between 1991 and 2005 (n=135). Cox proportional hazards models were used to determine the risk of graft failure (death or retransplant) in the lowest tertile SE group (low SE group) compared with the remaining 2 of 3 patients (controls). The 2 groups were similar with respect to age, gender, diagnosis, and year of transplant. White race was less frequent in low SE group (64% versus 90%, P=0.001). Graft failure occurred in 46 transplant recipients (40 deaths, 6 retransplant). Low SE group (hazard ratio 2.4, 95% CI 1.3 to 4.3) and nonwhite race (hazard ratio 2.7, 95% CI 1.4 to 5.2) were both associated with higher risk of graft failure. In a multivariable model controlling for diagnosis and pretransplant support, race, and low SE position (hazard ratio 2.0, 95% CI 1.0 to 3.7, P=0.04) remained associated with graft failure. Low SE position group had a higher incidence rate of graft rejection and was at a higher risk of late rejection. CONCLUSIONS Low SE position may be an independent risk factor for graft failure in pediatric heart transplant recipients.
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Affiliation(s)
- Tajinder P Singh
- Departments of Cardiology and Cardiovascular Surgery, Children's Hospital Boston, Harvard Medical School, and Harvard School of Public Health, Boston, Mass02115, USA.
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Chavers BM, Snyder JJ, Skeans MA, Weinhandl ED, Kasiske BL. Racial disparity trends for graft failure in the US pediatric kidney transplant population, 1980-2004. Am J Transplant 2009; 9:543-9. [PMID: 19260833 PMCID: PMC2652686 DOI: 10.1111/j.1600-6143.2008.02530.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Graft survival among adult African American kidney transplant patients remains low compared to whites, but little information is available for children and adolescents. We examined trends in graft failure among US incident primary kidney transplant patients aged <19 years (n = 13 692), 1980-2004. Trends in 1-year and 2- to 5-year graft failure (for patients whose grafts survived the first year) were analyzed in 5-year intervals. One-year graft failure declined 70% for white and 77% for African American patients over the 25-year period, and 1-year graft failure rates improved at a slightly higher rate for African American compared to white patients (p = 0.02). In contrast, the graft failure rates for years 2-5 declined 53% for white and only 41% for African American patients over the 25 years (p = 0.29). In fully adjusted Cox proportional hazards analysis, the rate of graft failure among African Americans was approximately 2-fold higher than for white patients over the entire study period. Graft survival has improved slightly more for African American than white pediatric patients over the past 25 years. However, graft survival for African American pediatric patients remains poor compared with white patients.
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Affiliation(s)
- BM Chavers
- University of Minnesota, Minneapolis, Minnesota,United States Renal Data System, Minneapolis, Minnesota
| | - JJ Snyder
- United States Renal Data System, Minneapolis, Minnesota
| | - MA Skeans
- United States Renal Data System, Minneapolis, Minnesota
| | - ED Weinhandl
- United States Renal Data System, Minneapolis, Minnesota
| | - BL Kasiske
- University of Minnesota, Minneapolis, Minnesota,United States Renal Data System, Minneapolis, Minnesota,Hennepin County Medical Center, Minneapolis, Minnesota
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Wu ZX, Yang SL, Wu WZ, Cai JQ, Wang QH, Wang D, Gao X, Liao LM, Tan JM. The long-term outcomes of pediatric kidney transplantation: a single-centre experience in China. Pediatr Transplant 2008; 12:215-8. [PMID: 18307671 DOI: 10.1111/j.1399-3046.2007.00814.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To explore the long-term outcomes of paediatric kidney transplantation and the effects of renal allograft on growth, education, employment, marriage and procreation. Twenty-seven children with ESRD received the renal allograft from 1985 to 2001. The patient and kidney survival rate, renal function, growth and employment, etc., were reviewed retrospectively. The average follow-up period was 10.3 +/- 4.4 yr. The one-, three-, five- and 10-yr graft survival rates were 96.3%, 88.9%, 81.5% and 66.7%, respectively, and the corresponding patient survival rates were 100%, 92.6%, 85.2% and 68.8%. The body weight gain was 4-10 kg in one-yr post-operative and the height increased 0-2 cm for girls and 2-5 cm for boys. A total of 44.4% of the recipients accomplished their education above junior high school. The employment rate was 46.2% in males, and 57.2% in females. Twelve patients were married. Non-adherence occurred in 30% of the recipients. Forty percent of the surviving recipients developed complications. Seven patients died. More attention should be paid to non-adherence of medications and more supports from the society are required to improve the life quality of paediatric recipients, especially in employment and education.
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Affiliation(s)
- Zhi-Xian Wu
- Transplant Center, General Hospital, Fuzhou, Fujian Province, China
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