{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T19:36:30Z","timestamp":1784662590495,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,3,14]],"date-time":"2018-03-14T00:00:00Z","timestamp":1520985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["234\u20102005\u2010370011C"],"award-info":[{"award-number":["234\u20102005\u2010370011C"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The kidney allocation system (<jats:styled-content style=\"fixed-case\">KAS<\/jats:styled-content>) altered pediatric candidate prioritization. We determined <jats:styled-content style=\"fixed-case\">KAS<\/jats:styled-content>'s impact on pediatric kidney recipients by examining delayed graft function (<jats:styled-content style=\"fixed-case\">DGF<\/jats:styled-content>) rates from 2010 to 2016. A propensity score\u2010matched pediatric recipients pre\u2010 and post\u2010<jats:styled-content style=\"fixed-case\">KAS<\/jats:styled-content>. A semiparametric decomposition analysis estimated the contributions of <jats:styled-content style=\"fixed-case\">KAS<\/jats:styled-content>\u2010related changes in donor characteristics and dialysis time on <jats:styled-content style=\"fixed-case\">DGF<\/jats:styled-content> rate. The unadjusted odds of <jats:styled-content style=\"fixed-case\">DGF<\/jats:styled-content> were 69% higher post\u2010<jats:styled-content style=\"fixed-case\">KAS<\/jats:styled-content> for young (&lt;10\u00a0years at listing) recipients (N\u00a0=\u00a01153, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.02) but were not significantly increased for older pediatric (10\u201017\u00a0years at listing) recipients (N\u00a0=\u00a02624, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.48). Post\u2010<jats:styled-content style=\"fixed-case\">KAS<\/jats:styled-content>, young recipients received significantly fewer pediatric (&lt;18\u00a0years) donor kidneys (21% vs 32%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01) and had longer median pretransplant dialysis time (603 vs 435\u00a0days, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01). After propensity score matching, post\u2010<jats:styled-content style=\"fixed-case\">KAS<\/jats:styled-content> status increased the odds of <jats:styled-content style=\"fixed-case\">DGF<\/jats:styled-content> in young recipients 71% (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.71, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.01\u20102.46). In decomposition analysis, 24% of the higher <jats:styled-content style=\"fixed-case\">DGF<\/jats:styled-content> rate post\u2010<jats:styled-content style=\"fixed-case\">KAS<\/jats:styled-content> was attributable to donor characteristics and 19% to increased recipient dialysis time. In a confirmatory survival analysis, <jats:styled-content style=\"fixed-case\">DGF<\/jats:styled-content> was associated with a 2.2 times higher risk of graft failure (<jats:styled-content style=\"fixed-case\">aHR<\/jats:styled-content>2.28, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.46\u20103.54). In conclusion, <jats:styled-content style=\"fixed-case\">KAS<\/jats:styled-content> may lead to worse graft survival outcomes in children. Allocation changes should be considered.<\/jats:p>","DOI":"10.1111\/ctr.13223","type":"journal-article","created":{"date-parts":[[2018,2,21]],"date-time":"2018-02-21T16:37:34Z","timestamp":1519231054000},"source":"Crossref","is-referenced-by-count":33,"title":["Impact of the kidney allocation system on young pediatric recipients"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6000-3153","authenticated-orcid":false,"given":"William Fiske","family":"Parker","sequence":"first","affiliation":[{"name":"Department of Medicine University of Chicago  Chicago IL USA"},{"name":"MacLean Center for Clinical Medical Ethics University of Chicago  Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lainie Friedman","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Chicago  Chicago IL USA"},{"name":"MacLean Center for Clinical Medical Ethics University of Chicago  Chicago IL USA"},{"name":"Department of Pediatrics University of Chicago  Chicago IL USA"},{"name":"Department of Surgery University of Chicago  Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"J.","family":"Richard Thistlethwaite","sequence":"additional","affiliation":[{"name":"MacLean Center for Clinical Medical Ethics University of Chicago  Chicago IL USA"},{"name":"Department of Surgery University of Chicago  Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy E.","family":"Gallo","sequence":"additional","affiliation":[{"name":"Department of Surgery Stanford University  Palo Alto CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,14]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2013.08.007"},{"key":"e_1_2_8_3_1","unstructured":"OPTN Kidney Committee.A Guide to Calculating and Interpreting the Kidney Donor Profile Index (KDPI).https:\/\/optn.transplant.hrsa.gov\/media\/1512\/guide_to_calculating_interpreting_kdpi.pdf. 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