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Inequality in pediatric kidney transplantation in Brazil
Paulo Cesar Koch Nogueira1,2, Maria Fernanda Camargo de Carvalho3, Luciana de Santis Feltran3,4
1Pediatric Renal Transplant Service, Hospital Samaritano de São Paulo, Sao Paulo, Sao Paulo, Brazil. pkoch.dped@epm.br.
Insights
Kidney transplant access for children in Brazil varies significantly by region, with socioeconomic factors playing a key role. Training healthcare professionals can help reduce these disparities in pediatric kidney transplantation.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Public Health Policy
Background:
- Access to kidney transplantation for children in Brazil is unevenly distributed across different regions.
- Factors influencing access to pediatric kidney transplantation require detailed investigation.
Purpose of the Study:
- To describe access to kidney transplantation for children in Brazil.
- To identify factors associated with undergoing kidney transplantation and waiting list removal in pediatric patients.
Main Methods:
- A cohort of 1211 children on the transplant list from 2011-2013 was analyzed.
- Regression models were used to investigate factors associated with deceased donor kidney transplantation and waiting list removal.
Main Results:
- Transplantation incidence varied widely, with the South having the highest rate and the Midwest the lowest.
- Children from the North and Midwest regions had a significantly lower probability of receiving a deceased donor transplant.
- Recipient age and Gross Domestic Product (GDP) influenced transplant outcomes, with younger children in certain regions facing lower chances.
Conclusions:
- Inequalities in pediatric kidney transplantation in Brazil are linked to macroeconomic factors.
- Targeted training for transplant center professionals caring for children can help mitigate these disparities.
Background:
The aim of this study was to describe the access and factors associated with kidney transplantation for children in different regions of Brazil.
Methods:
We analyzed a cohort of 1211 children enrolled on the transplant list from January 2011 to December of 2013. We fitted regression models to investigate factors associated with: (a) undergoing kidney transplantation from a deceased donor, and (b) being removed from the waiting list.
Results:
The incidence of transplantation was uneven across regions, with the lowest rate at 0.4 per million age-related population (pmarp) in the Midwest and the highest incidence rate of 8.3 cases pmarp in the South. Children from the North and the Midwest regions had a 3-4 times lower probability of undergoing a deceased donor transplant (p < 0.05). Apart from the geographic region, age of recipients and GDP influenced the outcome. The likelihood of undergoing transplantation was very low in the youngest children in the North and Midwest. The number of transplant centers was not associated with either outcome.
Conclusions:
Factors of inequality in transplantation in Brazil are of macroeconomic origin, but there is room to reduce inequalities. Training existing transplant center professionals in the care of children could diminish the discrepancies.
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