Related Experiment Video
Updated: Oct 14, 2025
High Throughput Sequential ELISA for Validation of Biomarkers of Acute Graft-Versus-Host Disease
Published on: October 31, 2012
Understanding disparities and barriers associated with pediatric transplant evaluation and time to listing: Moving
Elizabeth Steinberg Christofferson1,2,3, Elizabeth B Ruzicka3, Matthew Bolt4
1Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Insights
Delays in pediatric transplant listing are linked to social, administrative, and financial barriers. Addressing these issues, especially for liver transplant candidates, can reduce wait times and improve outcomes.
Area of Science:
- Pediatric Transplant Medicine
- Health Disparities Research
- Health Services Research
Background:
- Delayed time to listing (TTL) in pediatric transplant candidates increases mortality and morbidity risks.
- Existing research has not fully examined the spectrum of health disparities and barriers contributing to delayed transplant listing.
- Understanding these barriers is crucial for improving the evaluation process for pediatric transplant candidates.
Purpose of the Study:
- To examine sociodemographic factors and barriers associated with delayed time to listing (TTL) in pediatric transplant candidates.
- To identify mechanisms explaining differences in TTL among pediatric kidney, liver, and heart transplant candidates.
- To inform interventions aimed at reducing delays in the pediatric transplant candidate evaluation process.
Main Methods:
- Retrospective chart reviews of 183 pediatric transplant candidates (ages 0-18) evaluated between 2012-2015.
- Data collection included demographic information and potential barriers (social, medical, financial, caregiver-related).
- Statistical analyses included descriptive statistics, logistic regression, Cox proportional hazards models, and path analysis to model TTL.
Main Results:
- Financial barriers (71.6%) were most common, followed by caregiver psychological/substance use issues (57.9%) and medical problems (49.7%).
- Older age, kidney/liver organ type, and social, medical, administrative, and financial barriers were directly associated with longer TTL.
- Public insurance and organ type were indirectly linked to longer TTL through various mediating barriers.
Conclusions:
- Social, administrative, and financial issues significantly mediate delays in transplant listing, particularly for liver transplant candidates and those with public insurance.
- Interventions targeting these multifaceted barriers are necessary to reduce TTL and improve outcomes for pediatric transplant candidates.
- Addressing co-occurring barriers is essential for optimizing the transplant evaluation pathway.
Background:
Delayed time to listing (TTL) for pediatric transplant patients is associated with increased risks of mortality and morbidity. The full range of health disparities, sociodemographic factors, and other barriers associated with delays in listing in the pediatric transplant candidate evaluation process has not been fully examined.
Methods:
Retrospective chart reviews were conducted for 183 kidney, liver, and heart transplant candidates ages 0-18 who were referred for evaluation during 2012-2015. Demographic information and potential barriers (e g., social/medical factors, financial concerns) were gathered from pre-transplant evaluations and included in a comprehensive model to evaluate mechanisms that explain differences in TTL. Descriptive statistics, logistic regression models, Cox proportional hazards models, and path analysis were used for analyses.
Results:
Candidates included 26.8% heart, 33.3% liver, and 39.9% kidney patients. The most common barrier to listing was financial (71.6%), followed by caregiver psychological or substance use (57.9%), and medical problems (49.7%). Higher age, kidney, and liver organ type (relative to the heart), and presence of social, medical, administrative/motivation, and financial barriers were all directly associated with longer TTL. Public insurance was indirectly associated with TTL through social, administrative/motivation, and financial barriers. Organ type was indirectly associated with TTL through financial barriers.
Conclusions:
Results suggest social problems, administrative issues, and financial issues act as mechanisms through which insurance type and liver transplant candidates face increased risk of delays in transplant listing time. There are numerous clinical implications and interventions that are warranted to reduce TTL among pediatric transplant candidates with co-occurring barriers.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:16Kidney Transplant III: Nursing Management