Family support and caregiver involvement are important for access to pediatric pre-emptive kidney transplantation

Pre-emptive kidney transplantation (PKT) improves both lifespan and quality of life for children with stage 5 chronic kidney disease (CKD 5) and is the preferred modality of kidney replacement therapy. The potential crucial role of family and social support (FSS) in PKT is often overlooked. The objective of this study was to determine whether a supportive FSS is associated with improved access to PKT.

Retrospective single-center study examining associations among demographic, clinical, socioeconomic factors, and psychosocial and family assessments in children with CKD 5 from 2010 to 2020. Children who received a PKT were compared with dialysis-only and dialysis followed by KT recipients using Fisher's exact test, chi-square test, t-test, or Wilcoxon test, as appropriate. Multivariable logistic regression identified key predictors of PKT.

PKT was observed in 19.2% of the 177 patients who received a KT and was more prevalent among White males with underlying non-glomerular etiology, with private insurance, and with two caregivers. Living donors (LDs) were more common among recipients of a PKT. PKT recipients were more likely to report an adequate FSS network (97.1% vs. 71.2%, p = 0.001), greater parental supervision (94.1% vs. 75.5%, p = 0.017), and fewer comorbid psychiatric conditions (5.9% vs. 30.4%, p = 0.002). FSS was more strongly associated with the recipients of LDs than deceased donors' kidneys (98.5% vs. 68.4%, p < 0.001). Candidates with adequate FSS had an 8.86-fold higher odds of PKT (p = 0.038).

Adequate family social support was significantly associated with access to PKT. Emphasis should be placed on strengthening family support networks and bolstering caregivers' resilience to increase the likelihood of PKT among pediatric candidates.