Australian deceased donor kidney allocation protocols: Transplant waiting and graft quality for children and adolescents

Abstract

DD kidney allocation protocols may influence timing of transplantation and graft quality for pediatric recipients. This study aimed to evaluate the effects of these protocols, including pediatric priority, on waiting time on dialysis, transplant type, donor age, and HLA matching according to state of transplant in Australia. De-identified information on patients <15 yr of age who commenced RRT in NSW, Qld, and Victoria from 2002 to 2011 was retrieved from the ANZDATA. Transplant type, donor age, and HLA mismatching were compared between states, with competing risk regression used to examine the time to transplant. There were significant differences in waiting time to DD transplantation between the three states. Children in NSW and Qld waited a median of 14 and 11 months vs. 21 months in Victoria. The ratio of LD to DD transplants was lower in NSW and Qld. Differences correlated with DD pediatric priority in NSW and Qld. DDs in NSW were older than in the other states. HLA matching did not differ. DD kidney allocation protocols with pediatric priority in Australian states were associated with shorter waiting times and increased DD proportion.

A systematic review of social determinants of health in pediatric organ transplant outcomes

“…Likelihood and rate of transplantation varied significantly by region in the US 27,61,62 . Geographic variations in the incidence of transplant were similarly observed in Brazil, 56 as well as differences in donor characteristics and time to transplant across regions of Australia 63 . Few studies examined interactions between geographic regions and other SDoH.…”

“…27,61,62 Geographic variations in the incidence of transplant were similarly observed in Brazil, 56 as well as differences in donor characteristics and time to transplant across regions of Australia. 63 Few studies examined interactions between geographic regions and other SDoH. One study found no differences in rates of transplant when comparing White children and those of other identified racial or ethnic identity in the Midwestern US, 64 while another found regions in the US with the longest wait times also had the highest percentage of Hispanic children.…”

Time from kidney failure onset to transplantation and its impact on growth in pediatric patients

“…A study conducted in Australia and New Zealand examining the influence of deceased donor kidney allocation protocols, also found shorter waiting times 18 . However, this reduction in time to transplant is variable among developing countries.…”

“…In the present study, other factors were found to impact time to transplant, such as age at kidney failure, since children reaching stage 5 CKD before the age of 12 waited significantly longer for transplantation. Similarly, Le Page et al 18 identified recipient age as an important factor influencing timing of renal transplantation, noting that renal transplantation in young infants is rarely viable. In a study by our group, higher age at time of registration of pediatric patients on the transplant list was detected as a factor associated with greater probability of access to deceased donor transplantation.…”

“…16,17 A study conducted in Australia and New Zealand examining the influence of deceased donor kidney allocation protocols, also found shorter waiting times. 18 However, this reduction in time to transplant is variable among developing countries. The CKD registry in India showed that, in 2010, only 2% of kidney failure patients underwent transplantation, and the authors recommended that transplant centers should work together and frame a uniform acceptable allocation policy.…”