Socioeconomic Disparities in Preemptive Kidney Transplant Rates in Children

Area of Science:

• Pediatric Nephrology
• Transplantation Medicine
• Health Services Research

Background:

• Preemptive kidney transplantation in children improves outcomes compared to post-dialysis transplants.
• Rates of preemptive pediatric kidney transplantation remain suboptimal.
• Socioeconomic status (SES) may influence access to preemptive transplantation.

Purpose of the Study:

• To investigate the association between individual socioeconomic status (SES) and preemptive kidney transplantation in children.
• To evaluate if lower SES is linked to reduced rates of preemptive pediatric kidney transplants.

Main Methods:

• Retrospective analysis of 173 pediatric kidney transplant recipients (<18 years) transplanted between 2010-2020.
• Utilized the HOUSES index, a validated measure of individual SES based on housing units, categorized into quartiles (Q1: lower SES; Q2-Q4: higher SES).
• Applied mixed-effects multivariable logistic models to assess the impact of HOUSES on preemptive transplantation and pretransplant dialysis duration, adjusting for covariates.

Main Results:

• Of 173 recipients, 46 (26.6%) received a preemptive transplant.
• Lower SES (Q1) was significantly associated with lower odds of receiving a preemptive kidney transplant compared to higher SES (Q2-4) (Adjusted odds ratio [aOR]: 0.31; 95% CI: 0.11, 0.90; p=0.03), after adjusting for key factors.
• Among 109 recipients with dialysis data, 35.8% had dialysis duration exceeding one year.

Conclusions:

• Significant socioeconomic disparities exist in preemptive kidney transplantation rates among children.
• The HOUSES index effectively identified lower SES as a barrier to preemptive transplantation in pediatric kidney transplant recipients.
• Addressing socioeconomic factors is crucial to improve equitable access to preemptive kidney transplantation for children.