Has 2014 policy change affected racial disparities in pediatric kidney transplantation?

Racial and ethnic disparities in pediatric kidney transplantation have been described in multiple studies, but in December 2014, a U.S. policy change was implemented in part to improve equity in access to transplantation. A new study in CJASN has assessed the impact of this policy, called the Kidney Allocation System.

The study by Jill Krissberg, MD, MS (Ann & Robert H. Lurie Children's Hospital of Chicago/ Northwestern University Feinberg School of Medicine) and her colleagues included children on the U.S. kidney transplant list from 2008 to 2019. The investigators found no racial and ethnic disparities regarding time on the waitlist until transplantation either before or after the 2014 policy change. Racial and ethnic disparities did exist for time on dialysis until transplantation, but these disparities lessened after the 2014 policy change.

"The place that this policy change seemed to have the most effect was it helped make time on dialysis to transplantation even across all racial and ethnic groups when it wasn't before the policy change took effect. Times were even only after adjusting for patient and transplant related factors—such as blood type, age, where someone lives—meaning there are other factors affecting access to transplant for children of color that still need to be explored," said Dr. Krissberg. "A finding of our study that was a surprise to us is that children of all racial/ethnic groups waited longer for kidney transplants after this 2014 kidney allocation system change."