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Updated: Jul 3, 2025
Orthotopic Kidney Auto-Transplantation in a Porcine Model Using 24 Hours Organ Preservation And Continuous Telemetry
Published on: August 21, 2020
Progress made toward equitable transplantation in children and young adults with kidney disease
Mercedes Harford1, Marciana Laster2
1Division of Nephrology, Department of Pediatrics, School of Medicine, Indiana University, 699 Riley Hospital Drive, Rm 230, Indianapolis, IN, 46202, USA.
Insights
Racial disparities persist in pediatric kidney transplants despite system changes. Further research is needed to address remaining inequities in access and graft survival for minority children.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Health Equity
Background:
- Racial disparities in pediatric kidney transplantation are well-documented.
- These disparities affect preemptive transplantation, waitlisting, time to transplant, living donation, and graft outcomes.
- Previous organ allocation system changes (Share 35, KAS) have partially addressed, but not fully resolved, these inequities.
Purpose of the Study:
- To analyze the impact of organ allocation system changes on racial-ethnic disparities in pediatric kidney transplantation.
- To identify persistent disparities in transplant access and graft survival.
- To explore the role of social determinants of health in mediating these disparities.
Main Methods:
- Analysis of pediatric kidney transplant data over two decades.
- Evaluation of changes in the organ allocation system, including Share 35 and the Kidney Allocation System (KAS).
- Assessment of disparities in preemptive transplantation, waitlisting, time to transplant, living donation, and graft outcomes.
Main Results:
- Organ allocation system changes have resolved some, but not all, racial-ethnic disparities.
- Disparities persist in preemptive transplantation, time to waitlisting, and living donor transplantation.
- Racial disparities in graft survival, though improving under KAS, remain.
Conclusions:
- Racial disparities in pediatric kidney transplant access and graft survival are an international issue.
- Social determinants of health (financial access, language barriers, living donor availability) significantly mediate these disparities.
- Further investigation into modifiable social, biological, and cultural factors is crucial to eliminate transplant outcome disparities.
Abstract:
Racial disparities in pediatric kidney transplantation have been well described over the last two decades and include disparities in preemptive transplantation, waitlisting, time from activation to transplantation, living donation, and graft outcomes. Changes to the organ allocation system including the institution of Share 35 in 2005 and the Kidney Allocation System (KAS) of 2014 have resulted in resolution of some, but not all racial-ethnic disparities. Despite overall improvements in time from waitlist activation to transplant, disparities remain in preemptive transplantation, time to waitlisting, and living donor transplantation. Although improving under the KAS, racial disparities remain in graft survival as well. Racial disparity in kidney transplant access and graft survival is an international problem within pediatric nephrology. Although the racial group affected may differ, various minoritized pediatric groups across the world are affected by transplant disparities. Social determinants of health including financial access, language barriers, and the presence of a healthy living donor play a role in mediating these disparities. Further investigation is needed to better understand and intervene upon modifiable social, biological, and cultural factors driving the remaining disparity in transplant outcomes.
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