Impact of multiorgan and kidney-pancreas allocation policies on pediatric kidney-alone transplant candidates in the United States.
allocation
kidney
multiorgan transplant
pediatrics
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
revised:
06
06
2022
received:
11
04
2022
accepted:
01
09
2022
pubmed:
23
9
2022
medline:
18
11
2022
entrez:
22
9
2022
Statut:
ppublish
Résumé
The United States organ allocation policies prioritize kidney-pancreas and other multiorgan candidates above pediatric kidney-alone candidates, but the effects of these policies are unclear. We used OPTN data to describe trends in multiorgan and kidney-pancreas transplantation and identify 377 next-sequential pediatric kidney-alone candidates between 4/1/2015 and 10/31/2019 for individual-level analysis. Eleven percent of all kidneys were allocated as part of a multiorgan or kidney-pancreas transplant and 6% of pediatric kidney candidates were impacted. Pediatric next-sequential candidates accrued a median of 118 days (IQR 97-135 days) of additional wait time, and this was significantly longer for children who were Hispanic (p = .02), blood type B or O (p = .01), or had a cPRA ≥20% (p < .01). Eight pediatric next-sequential candidates (2%) were removed from the waitlist due to death or "too sick to transplant." 63% were transplanted with a kidney with a higher KDPI than the original multiorgan match (p < .01). Donor service areas with higher volumes of kidney-pancreas transplants had significantly longer additional wait times for pediatric next-sequential candidates (p = .01). Current allocation policy results in longer waiting times and higher KDPI kidneys for pediatric kidney candidates. As multiorgan transplant volume is increasing, further consideration of allocation policy is necessary to maximize equality and utility.
Sections du résumé
BACKGROUND
The United States organ allocation policies prioritize kidney-pancreas and other multiorgan candidates above pediatric kidney-alone candidates, but the effects of these policies are unclear.
METHODS
We used OPTN data to describe trends in multiorgan and kidney-pancreas transplantation and identify 377 next-sequential pediatric kidney-alone candidates between 4/1/2015 and 10/31/2019 for individual-level analysis.
RESULTS
Eleven percent of all kidneys were allocated as part of a multiorgan or kidney-pancreas transplant and 6% of pediatric kidney candidates were impacted. Pediatric next-sequential candidates accrued a median of 118 days (IQR 97-135 days) of additional wait time, and this was significantly longer for children who were Hispanic (p = .02), blood type B or O (p = .01), or had a cPRA ≥20% (p < .01). Eight pediatric next-sequential candidates (2%) were removed from the waitlist due to death or "too sick to transplant." 63% were transplanted with a kidney with a higher KDPI than the original multiorgan match (p < .01). Donor service areas with higher volumes of kidney-pancreas transplants had significantly longer additional wait times for pediatric next-sequential candidates (p = .01).
CONCLUSIONS
Current allocation policy results in longer waiting times and higher KDPI kidneys for pediatric kidney candidates. As multiorgan transplant volume is increasing, further consideration of allocation policy is necessary to maximize equality and utility.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14394Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 The Authors. Pediatric Transplantation published by Wiley Periodicals LLC.
Références
OPTN. National data. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#. Accessed October 15, 2021.
OPTN. Ethical Implications of Multi-Organ Transplants OPTN Ethics Committee. OPTN; 2019.
Trillium Gift of Life Network. Policies: Wait List, Organ Offers, and Allocation. Trillium Gift of Life Network; 2019.
NHS Blood and Transplant. POL200/5-introduction to patient selection and organ allocation policies controlled if copy number stated on document and issued by QA. 2021. Published Online.
OPTN. Ethical principles of pediatric organ allocation. https://optn.transplant.hrsa.gov/resources/ethics/ethical-principles-of-pediatric-organ-allocation/. Accessed June 23, 2021.
Gorman G, Frankenfield D, Fivush B, Neu A. Linear growth in pediatric hemodialysis patients. Pediatr Nephrol. 2008;23(1):123-127. doi:10.1007/s00467-007-0631-y
Mendley SR, Matheson MB, Shinnar S, et al. Duration of chronic kidney disease reduces attention and executive function in pediatric patients. Kidney Int. 2015;87(4):800-806. doi:10.1038/ki.2014.323
Neu AM, Bedinger M, Fivush BA, et al. Growth in adolescent hemodialysis patients: data from the centers for Medicare & Medicaid Services ESRD clinical performance measures project. Pediatr Nephrol. 2005;20(8):1156-1160. doi:10.1007/S00467-005-1889-6
Hooper SR, Gerson AC, Butler RW, et al. Neurocognitive functioning of children and adolescents with mild-to-moderate chronic kidney disease. Clin J Am Soc Nephrol. 2011;6(8):1824-1830. doi:10.2215/CJN.09751110
Tong A, Henning P, Wong G, et al. Experiences and perspectives of adolescents and young adults with advanced ckd. Am J Kidney Dis. 2013;61(3):375-384. doi:10.1053/j.ajkd.2012.09.024
Klare B, Montoya CR, Fischer DC, Stangl MJ, Haffner D. Normal adult height after steroid-withdrawal within 6 months of pediatric kidney transplantation: a 20 years single center experience. Transpl Int. 2012;25(3):276-282. doi:10.1111/j.1432-2277.2011.01400.x
Icard P, Hooper SR, Gipson DS, Ferris ME. Cognitive improvement in children with CKD after transplant. Pediatr Transplant. 2010;14(7):887-890. doi:10.1111/j.1399-3046.2010.01359.x
Westphal SG, Langewisch ED, Robinson AM, et al. The impact of multi-organ transplant allocation priority on waitlisted kidney transplant candidates. Am J Transplant. 2021;21(6):2161-2174. doi:10.1111/ajt.16390
Seikaly MG, Salhab N, Gipson D, Yiu V, Stablein D. Stature in children with chronic kidney disease: analysis of NAPRTCS database. Pediatr Nephrol. 2006;21(6):793-799. doi:10.1007/s00467-006-0040-7
Hooper SR, Gerson AC, Butler RW, et al. Neurocognitive functioning of children and adolescents with mild-to-moderate chronic kidney disease. Clin J Am Soc Nephrol. 2011;6(8):1824-1830. doi:10.2215/CJN.09751110
Nissel R, Brázda I, Feneberg R, et al. Effect of renal transplantation in childhood on longitudinal growth and adult height. Kidney Int. 2004;66(2):792-800. doi:10.1111/j.1523-1755.2004.00805.x
Ellis D. Growth and renal function after steroid-free tacrolimus-based immunosuppression in children with renal transplants. Pediatr Nephrol. 2000;14:689-694. doi:10.1007/s004670000335 Springer Verlag.
OPTN. EPTS Calculator. https://optn.transplant.hrsa.gov/resources/allocation-calculators/epts-calculator/. Accessed June 23, 2021.
Optn. Eliminate the Use of DSA and Region from Pancreas Allocation Policy. 2019. https://optn.transplant.hrsa.gov/media/3104/kidney_publiccomment_201908.pdf
Electronic Code of Federal Regulations (eCFR). https://www.ecfr.gov/cgi-bin/text-idx?SID=bb60e0a7222f4086a88c31211cac77d1&mc=true&node=pt42.1.121&rgn=div5#se42.1.121_18. Accessed June 23, 2021.
Fu Y, Cao Y, Wang H, et al. Metabolic outcomes and renal function after simultaneous kidney/pancreas transplantation compared with kidney transplantation alone for type 2 diabetes mellitus patients. Transpl Int. 2021;21:1198-1211. doi:10.1111/tri.13892
Hau HM, Jahn N, Brunotte M, et al. Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft. BMC Endocr Disord. 2020;20(1):30. doi:10.1186/s12902-020-0506-9
[USC05]. 42 USC 274: organ procurement and transplantation network. https://uscode.house.gov/view.xhtml?req=. Accessed June 23, 2021. (Title:42 section:274 edition:prelim).