scholarly journals Effects of COVID19 Pandemic on Pediatric Kidney Transplant in the United States

2020 ◽  
Author(s):  
Olga Charnaya ◽  
Teresa Po-Yu Chiang ◽  
Richard Wang ◽  
Jennifer Motter ◽  
Brian Boyarsky ◽  
...  
Keyword(s):  
United States ◽  
Kidney Transplantation ◽  
Disease Transmission ◽  
National Level ◽  
Rapid Change ◽  
Deceased Donor ◽  
The United States ◽  
Transplant Recipients ◽  
Pediatric Kidney Transplantation ◽  
Sustained Effect

Abstract In March 2020, COVID-19 infections began to rise exponentially in the United States, placing substantial burden on the healthcare system. As a result, there was a rapid change in transplant practices and policies, with cessation of most procedures. Our goal was to understand changes to pediatric kidney transplantation (KT) at the national level during the COVID-19 epidemic. Using SRTR data, we examined changes in pediatric waitlist registration, waitlist removal or inactivation, and deceased donor and living donor (DDKT/LDKT) events during the start of the disease transmission in the United States compared to the same time the previous year. We saw an initial decrease in DDKT and LDKT by 47% and 82% compared to expected events and then a continual increase, with numbers reaching expected pre-pandemic levels by May 2020. In the early phase of the pandemic, waitlist inactivation and removals due to death or deteriorating condition rose above expected values by 152% and 189%, respectively. There was a statistically significant decrease in new waitlist additions (IRR 0.49 0.65 0.85) and LDKT (IRR 0.17 0.38 0.84) in states with high vs low COVID activity. Transplant recipients during the pandemic were more likely to have received a DDKT, but had similar cPRA, waitlist time and cause of ESRD as before the pandemic. The COVID-19 pandemic initially reduced access to kidney transplantation among pediatric patients in the United States, but has not had a sustained effect.

scholarly journals Trends in Disparities in Preemptive Kidney Transplantation in the United States

2019 ◽  
Vol 14 (10) ◽  
pp. 1500-1511 ◽  
Author(s):  
Kristen L. King ◽  
Syed Ali Husain ◽  
Zhezhen Jin ◽  
Corey Brennan ◽  
Sumit Mohan
Keyword(s):  
United States ◽  
Kidney Transplantation ◽  
Private Insurance ◽  
Deceased Donor ◽  
The United States ◽  
Transplant Recipients ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
Medicare Patients ◽  
Preemptive Transplantation

Background and objectivesLong wait times for deceased donor kidneys and low rates of preemptive wait-listing have limited preemptive transplantation in the United States. We aimed to assess trends in preemptive deceased donor transplantation with the introduction of the new Kidney Allocation System (KAS) in 2014 and identify whether key disparities in preemptive transplantation have changed.Design, setting, participants, & measurementsWe identified adult deceased donor kidney transplant recipients in the United States from 2000 to 2018 using the Scientific Registry of Transplant Recipients. Preemptive transplantation was defined as no dialysis before transplant. Associations between recipient, donor, transplant, and policy era characteristics and preemptive transplantation were calculated using logistic regression. To test for modification by KAS policy era, an interaction term between policy era and each characteristic of interest was introduced in bivariate and adjusted models.ResultsThe proportion of preemptive transplants increased after implementation of KAS from 9.0% to 9.8%, with 1.10 (95% confidence interval [95% CI], 1.06 to 1.14) times higher odds of preemptive transplantation post-KAS compared with pre-KAS. Preemptive recipients were more likely to be white, older, female, more educated, hold private insurance, and have ESKD cause other than diabetes or hypertension. Policy era significantly modified the association between preemptive transplantation and race, age, insurance status, and Human Leukocyte Antigen zero-mismatch (interaction P<0.05). Medicare patients had a significantly lower odds of preemptive transplantation relative to private insurance holders (pre-KAS adjusted OR, [aOR] 0.26; [95% CI, 0.25 to 0.27], to 0.20 [95% CI, 0.18 to 0.22] post-KAS). Black and Hispanic patients experienced a similar phenomenon (aOR 0.48 [95% CI, 0.45 to 0.51] to 0.41 [95% CI, 0.37 to 0.45] and 0.43 [95% CI, 0.40 to 0.47] to 0.40 [95% CI, 0.36 to 0.46] respectively) compared with white patients.ConclusionsAlthough the proportion of deceased donor kidney transplants performed preemptively increased slightly after KAS, disparities in preemptive kidney transplantation persisted after the 2014 KAS policy changes and were exacerbated for racial minorities and Medicare patients.

Association between Longer Travel Distance for Transplant Care and Access to Kidney Transplantation and Graft Survival in the United States

2021 ◽  
pp. ASN.2020081242
Author(s):  
Adrian M. Whelan ◽  
Kirsten L. Johansen ◽  
Sandeep Brar ◽  
Charles E. McCulloch ◽  
Deborah B. Adey ◽  
...  
Keyword(s):  
United States ◽  
Kidney Transplantation ◽  
Graft Failure ◽  
Living Donor ◽  
Deceased Donor ◽  
The United States ◽  
Travel Distance ◽  
Transplant Center ◽  
Living Donor Transplantation ◽  
Transplant Candidates

BackgroundTransplant candidates may gain an advantage by traveling to receive care at a transplant center that may have more favorable characteristics than their local center. Factors associated with longer travel distance for transplant care and whether the excess travel distance (ETD) is associated with access to transplantation or with graft failure are unknown.MethodsThis study of adults in the United States wait-listed for kidney transplantation in 1995–2015 used ETD, defined as distance a patient traveled beyond the nearest transplant center for initial waiting list registration. We used linear regression to examine patient and center characteristics associated with ETD and Fine–Gray models to examine the association between ETD (modeled as a spline) and time to deceased or living donor transplantation or graft failure.ResultsOf 373,365 patients, 11% had an ETD≥50 miles. Traveling excess distance was more likely among patients who were of non-Black race or those whose nearest transplant center had lower annual living donor transplant volume. At an ETD of 50 miles, we observed a lower likelihood of deceased donor transplantation (subhazard ratio [SHR], 0.85; 95% confidence interval [95% CI], 0.84 to 0.87) but higher likelihood of living donor transplantation (SHR, 1.14; 95% CI, 1.12 to 1.16) compared with those who received care at their nearest center. ETD was weakly associated with higher risk of graft failure.ConclusionsPatients who travel excess distances for transplant care have better access to living donor but not deceased donor transplantation and slightly higher risk of graft failure. Traveling excess distances is not clearly associated with better outcomes, especially if living donors are unavailable.

Clinical Management of Kidney Transplant Recipients

2019 ◽  
pp. 457-459
Author(s):  
James A. Onigkeit
Keyword(s):  
United States ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Clinical Management ◽  
Living Donor ◽  
Kidney Transplant Recipient ◽  
Deceased Donor ◽  
The United States ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Kidney transplant is common. More than 19,000 kidney transplants were performed in the United States in 2017. About two-thirds were deceased donor transplants, and about one-third were living donor transplants. The clinical management of a kidney transplant recipient begins in the operating room. Posttransplant complications can be divided into 2 categories: surgical and medical.

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