Kidney Week

Abstract: SA-PO1209

eGFR at the Time of Wait-Listing in Pediatric Kidney Transplant Candidates

Session Information

• Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Engen, Rachel M., University of Wisconsin-Madison, Madison, Wisconsin, United States

Rachel M. Engen, MD, MS

• Perkins, James D., University of Washington, Seattle, Washington, United States

James D. Perkins, MD

• Harshman, Lyndsay, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Lyndsay Harshman, MD, MS

• Kazi, Amber Jasmine, University of Washington, Seattle, Washington, United States

Amber Jasmine Kazi, MD

• Lindner, Clare Joan, University of Michigan, Ann Arbor, Michigan, United States

Clare Joan Lindner, MD

• Smith, Jodi M., University of Washington, Seattle, Washington, United States

Jodi M. Smith, MD, MPH

• Bartosh, Sharon M., University of Wisconsin-Madison, Madison, Wisconsin, United States

Sharon M. Bartosh, MD

• Barletta, Gina-Marie, Oregon Health & Science University, Portland, Oregon, United States

Gina-Marie Barletta, MD

Background

OPTN policy does not restrict listing of pediatric candidates based on eGFR for the purpose of accruing waitlist time, and reporting of eGFR at listing is not required.

Methods

Retrospective cohort study of OPTN data to describe eGFR for kidney-alone candidates listed prior to age 18 years between 1/1/2022 and 12/31/2024. Candidates on dialysis at listing were excluded. The primary outcome was progression to transplant before study end date of 3/31/25.

Results

1590 pediatric kidney candidates were waitlisted preemptively during the study period. 916 (57.6%) had no documented eGFR. Of those with documented eGFR, 96.8% reported an eGFR <20 ml/min/1.73m². There was wide variation in reporting across OPTN Regions; 90.5% of candidates in Region 4 had reported eGFR compared to 12.3% in Region 5. Median time on the waitlist was 154 days (IQR 66-289 days) for candidates with a reported eGFR compared to 223 days (IQR 126-396 days) for patients without. Within the study period, 60.7% of those with reported eGFR received a kidney transplant compared to 27.8% of those without. There was a higher incidence of living donor transplant among those without a reported eGFR.

Conclusion

There is significant variation in reporting of eGFR at pediatric kidney waitlisting. Lower transplant rates and longer waitlist times among patients without a reported eGFR suggest that these patients are waitlisted earlier in the course of their disease. As time on the waitlist is the primary driver of kidney allocation, this finding raises important concerns about equity in access to transplantation. The OPTN should require reporting of eGFR for all pediatric candidates at time of listing to monitor for disparities.

Reporting of eGFR and progression to transplant for pediatric kidney candidates.

Reporting of eGFR among pediatric kidney candidates by OPTN Region.