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Kidney Week

Abstract: PO1097

Kidney Transplant Access Among Children and Young Adults on Dialysis in the United States

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Okuda, Yusuke, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Tantisattamo, Ekamol, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Laster, Marciana, University of California Los Angeles, Los Angeles, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

Only 20% of children and young adults with advanced CKD receive preemptive kidney transplant (KT). This study aimed to investigate secular trends in KT access among incident US dialysis patients who were ≤21 years old.

Methods

In a cohort of incident dialysis patients ≤21 years of age who initiated dialysis between 1995-2014 from the USRDS database, we examined secular trends in the likelihood of receiving KT, using a Cox proportional hazards regression.

Results

Among 24,860 patients, the median (IQR) age at dialysis initiation was 17 (11–20) years of age, among whom 56% were <18 years old. A total of 16,912 (68%) patients underwent a KT during a median (IQR) follow-up of 2.0 (0.9–4.3) years (total follow-up: 82,244 patient-years). The 1-, 2-, and 3-year probabilities of receiving a KT were 23%, 43%, and 55%, respectively. The likelihood of receiving KT slightly improved but decreased after 2005 among patients <18 years old; a decreasing trend was remarkable among patients ≥18 years old [Figure A]. While increasing among patients <18 years old, the likelihood of receiving a deceased donor transplant declined among those ≥18 years old. For a living donor transplant, there were decreasing trends in both age groups [Figure B].

Conclusion

While the likelihood of receiving pediatric KT declined over two decades, there was an increase in deceased donor transplantation among those <18 years old. Since biological factors determine unmet need for KT in pediatric or young adult populations having short waiting time, an old kidney allocation system (KAS), which achieved the goal by transplanting patients with the longest waiting time, may not improve transplant access and outcomes. A new KAS commenced in December 2014, and living donor transplant may provide different trends or improve pediatric KT access, although further long-term studies are needed.

Figure: Time-to-event outcomes for receiving a kidney transplant among pediatrics(<18 years old) and young adults (≥18 years old) between 1995 and 2014.
A. Unadjusted and case-mixed adjusted models
B: Stratified into living and deceased donor renal transplantations