Abstract: SA-PO391
Distance to Transplant Center and Pediatric Kidney Transplant Outcomes and Access to Care
Session Information
- Pediatric Nephrology - III
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Armstrong, Sierra, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Russell, Gregory B., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- South, Andrew M., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Chen, Ashton, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
Background
Reliable transportation is necessary for equitable healthcare access. Transportation insecurity poses a barrier to care, contributing to worse health outcomes in chronic disease. However its significance in pediatric transplantation is an area of ongoing investigation. Our aim was to assess the impact of distance to the transplant center on outcomes and post-transplant follow-up care in a geographically diverse cohort of pediatric transplant recipients.
Methods
In a single-center retrospective cohort study, data were extracted from the electronic health record using biomedical informatics methods. Inclusion criteria were youth 0-18 years who received a kidney transplant and had post-transplant care at our center from 9/25/2012–12/31/2022. Our exposure was distance to the transplant center, determined by calculating geodetic distance from participants’ residence zip code to the transplant center. Outcomes were graft survival, biopsy-proven acute rejection (BPAR), hospitalization rates, and no-shows and cancelled appointments in the transplant clinic. We used Kaplan-Meier curves and Cox proportional hazards regression to estimate associations of exposures with outcomes.
Results
Of 78 participants, 37% were female; median age at transplant was 8.5 years (IQR 3,14); median follow-up was 5.0 years (IQR 1,7.0). The median distance to the transplant center was 29.0 miles (IQR 13.4,60.1); mean no-show proportion was 8.9% (SD 8.1%); mean cancellation proportion was 26.3% (SD 10.6%). Distance to the transplant center was not associated with higher risk of graft failure, shorter time to first BPAR, higher BPAR, and higher hospitalization rates. Greater distance from the transplant center was associated with a higher proportion of cancelled clinic appointments (p 0.0001, Beta coefficient 1.08 per 10 miles, 95% CI (0.63,1.54)).
Conclusion
Greater distance to the transplant center was associated with more clinic cancellations, which can cause delayed care resulting in negative effects on transplant health. Further study by collecting qualitative data on patient transportation access may help us understand the patient experience and what barriers can be mitigated to reduce appointment cancellations. By collecting qualitative data on patient transportation access in this population, we hope to better inform transplant maintenance and optimize long-term care.
Funding
- Other NIH Support