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Impact of the kidney allocation system on young pediatric recipients
Author(s) -
Parker William Fiske,
Ross Lainie Friedman,
Richard Thistlethwaite J.,
Gallo Amy E.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13223
Subject(s) - medicine , propensity score matching , dialysis , odds ratio , renal function , odds , urology , logistic regression
The kidney allocation system ( KAS ) altered pediatric candidate prioritization. We determined KAS 's impact on pediatric kidney recipients by examining delayed graft function ( DGF ) rates from 2010 to 2016. A propensity score‐matched pediatric recipients pre‐ and post‐ KAS . A semiparametric decomposition analysis estimated the contributions of KAS ‐related changes in donor characteristics and dialysis time on DGF rate. The unadjusted odds of DGF were 69% higher post‐ KAS for young (<10 years at listing) recipients (N = 1153, P = .02) but were not significantly increased for older pediatric (10‐17 years at listing) recipients (N = 2624, P = .48). Post‐ KAS , young recipients received significantly fewer pediatric (<18 years) donor kidneys (21% vs 32%, P < .01) and had longer median pretransplant dialysis time (603 vs 435 days, P < .01). After propensity score matching, post‐ KAS status increased the odds of DGF in young recipients 71% ( OR 1.71, 95% CI 1.01‐2.46). In decomposition analysis, 24% of the higher DGF rate post‐ KAS was attributable to donor characteristics and 19% to increased recipient dialysis time. In a confirmatory survival analysis, DGF was associated with a 2.2 times higher risk of graft failure ( aHR 2.28, 95% CI 1.46‐3.54). In conclusion, KAS may lead to worse graft survival outcomes in children. Allocation changes should be considered.