INTRODUCTION: The distance traveled by adults to kidney transplant centers contributes to disparities in access and outcomes. We hypothesized that distance would adversely affect the time to transplantation and waitlist mortality for pediatric kidney transplant candidates.

METHODS: The Scientific Registry of Transplant Recipients was queried for isolated pediatric kidney transplant waitlist registrants (under age 18) from 2003 to 2012. Direct distance from home ZIP code centroid to listing transplant center was calculated in miles. We performed a competing events analysis, clustered by listing center, for death on the waitlist and transplantation after adjusting for demographic factors, socioeconomic status, prior kidney transplantation, and indication.

RESULTS: 8,845 pediatric patients met inclusion criteria. The median distance to listing transplant center was 28 (IQR 10.6-78.3) miles. In adjusted competing risks analysis, longer distance was not associated with prolonged waiting to transplantation (HR 1.01, P = 0.93), but Black race (HR 0.80, P < 0.001), Hispanic ethnicity (HR = 0.93, P = 0.04), and prior kidney transplant (HR 0.31, P < 0.001) were. However, the risk of death on the waitlist was significantly greater for patients who lived furthest from their transplant centers (HR 1.84, longest versus shortest distance quartile, P < 0.001); additional risk factors associated with death were female sex (HR 1.65, P < 0.001).

CONCLUSIONS: The higher waitlist mortality associated with increasing distance may be related to decreased access to specialist and tertiary care associated with a transplant center or poor social supports for families that live closer to the transplant center. Policy interventions to improve pediatric kidney transplantation could consider outreach programs and more intensive monitoring protocols for patients who live far away, or stronger support systems for their families who travel to be listed.

CITATION INFORMATION: Adler J, Bababekov Y, Markmann J, Chang D, Yeh H. Pediatric Kidney Transplantation and Mortality: Distance to Transplant Center Matters. Am J Transplant. 2016;16 (suppl 3).

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