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Kidney Week

Abstract: SA-PO390

Recipient Proximity to Transplant Center in US Pediatric Kidney Transplantation

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

  • Douglas, Chloe E., Seattle Children's Hospital, Seattle, Washington, United States
  • Smith, Jodi M., Seattle Children's Hospital, Seattle, Washington, United States
  • Perkins, James D., University of Washington School of Medicine, Seattle, Washington, United States
  • Wightman, Aaron G., Seattle Children's Hospital, Seattle, Washington, United States
  • Ng, Yue-Harn, University of Washington School of Medicine, Seattle, Washington, United States
  • Engen, Rachel M., University of Wisconsin-Madison, Madison, Wisconsin, United States
Background

Recipient proximity to a transplant center varies greatly among US children with kidney failure. Prior studies of US children listed for kidney transplant demonstrated that less proximity to center was associated with greater risk of death on the waitlist. Using data from the Scientific Registry of Transplant Recipients, we describe the association between recipient proximity to transplant center and candidate evaluation and outcomes in US pediatric kidney transplant recipients.

Methods

US children <18 years of age at time of listing who underwent kidney transplantation from January 1st, 2001, to December 31st, 2019 (n=12,113) met inclusion criteria. Proximity to transplant center was calculated using recipient and transplant center ZIP codes at time of listing. Logistic and linear regression, in addition to multivariable Cox proportional hazard models, were utilized to analyze outcomes of interest.

Results

Seventy-five percent of recipients lived within 83 miles of a transplant center at time of listing. A majority of Black recipients (81.8%) lived within 83 miles (<75th percentile) of a center, compared to 72.3% of white recipients. Twenty-three percent of recipients in the >75th percentile had a primary diagnosis of FSGS, versus 28% in the <25th percentile. Proportions of pre-emptive transplant and public insurance were similar across strata. There was no significant difference in survival across strata, with those with least proximity to center having no increased risk of graft failure (aHR 0.96, 95% CI: 0.87-1.06). There was no change in odds of living donor transplantation (aOR 1.01, 95% CI: 0.99-1.03) or delayed graft function (aOR 0.98, 95% CI: 0.95-1.02) with each 100-mile increase from center. Residing within the >75th percentile at time of listing increased waitlist time by 3% of one year (10.95 days, 95% CI: 0.6-6%).

Conclusion

No meaningful associations between recipient proximity to center and graft survival, waitlist time, living donor transplantation, or delayed graft function were detected. Future efforts should explore the impact of proximity to center on additional aspects of transplant access, recipient well-being, and caregiver burden.

Funding

  • NIDDK Support