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

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

BACKGROUND

In children with kidney failure, the longer the duration of dialysis the greater the impact on growth deficit, quality of life, and life expectancy. The aim of this research is to test whether there was a shortening of treatment time from kidney failure to transplantation in pediatric patients and whether this time interval impacted height.

METHODS

Observational retrospective cohort study from 2005 to 2018. The first outcome variable was time to transplantation in years, while the second was height/age standard deviation score (SDS) at transplantation. Cox regression models were used to analyze time from disease to transplantation and linear regression was employed to test the association of the year of kidney failure onset with height.

RESULTS

A total of 780 children were evaluated and 517 underwent kidney transplantation after a median time of 1.9 years (IQR = 1.0-4.0). The variables significantly associated with time to transplant were: year of kidney failure onset (HR = 1.07; 95% CI: 1.05-1.10; p < .001), age at kidney failure onset <12 years (HR = 0.59; 95% CI: 0.49-0.71; p < .001), living in different state as transplant center (HR = 0.63; 95% CI: 0.53-0.77; p < .001), and undergoing blood transfusion before transplantation (HR = 0.63; 95% CI: 0.53-0.75; p < .001). Regarding growth, for each 1-year increase in the epoch of kidney failure onset, a 0.05 SDS raise in height/age is expected (p < .001).

CONCLUSION

Children with recent kidney failure onset had significantly lower time to the outcome and this reduction was associated with a less severe growth deficit.

Models of Quality Management Systems Applied in Specialized Services for the Donation and Transplantation of Human Organs and Tissues

BACKGROUND

Quality management tools and models are used to improve processes and products, including those related to organ and tissue donation and transplantation protocols. This study aims to map, discuss, and disseminate models/tools of quality management systems applied in health services, specializing in the donation and/or transplantation of human organs and tissues.

METHODS

This is an integrative literature review over the last 10 years, operationalized through searches carried out on the PubMed portal and the databases: SciVerse Scopus (SCOPUS), Scielo, Latin American and Caribbean Literature on Health Sciences (LILACS), Nursing Database (BDENF), and the Virtual Health Library (BVS). The organization of search results in the databases and the election of articles compatible with the guiding question and the inclusion and exclusion criteria for this study took place through the online and free application platform Rayyan.

RESULTS

Six hundred seventy-eight records were found, of which, after careful analysis, 18 articles were considered relevant to the theme. We identified 17 quality management models and/or tools that emphasize using scientifically proven and/or validated techniques to reduce or eliminate the possibility of risks in the processes that permeate the stages of donation and transplantation of organs and tissues.

CONCLUSION

This review brought the possible tools used and published, which can be perceived, reproduced, and improved, through the role of the multidisciplinary team in specialized centers for the donation and transplantation of human organs and tissues, aiming to offer a process of continuous improvement management to deliver better products and services.

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

BACKGROUND

Equitable access to pediatric organ transplantation is critical, although risk factors negatively impacting pre- and post-transplant outcomes remain. No synthesis of the literature on SDoH within the pediatric organ transplant population has been conducted; thus, the current systematic review summarizes findings to date assessing SDoH in the evaluation, listing, and post-transplant periods.

METHODS

Literature searches were conducted in Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases.

RESULTS

Ninety-three studies were included based on pre-established criteria and were reviewed for main findings and study quality. Findings consistently demonstrated disparities in key transplant outcomes based on racial or ethnic identity, including timing and likelihood of transplant, and rates of rejection, graft failure, and mortality. Although less frequently assessed, variations in outcomes based on geography were also noted, while findings related to insurance or SES were inconsistent.

CONCLUSION

This review underscores the persistence of SDoH and disparity in equitable transplant outcomes and discusses the importance of individual and systems-level change to reduce such disparities.