{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:47:55Z","timestamp":1786373275927,"version":"build-2736575974"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","funder":[{"name":"John M. Sobrato Gift Fund"},{"DOI":"10.13039\/100015521","name":"Stanford Maternal and Child Health Research Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100015521","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["T32HS026128"],"award-info":[{"award-number":["T32HS026128"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>In December 2014, the Kidney Allocation System (KAS) was implemented to improve equity in access to transplantation, but preliminary studies in children show mixed results. Thus, we aimed to assess how the 2014 KAS policy change affected racial and ethnic disparities in pediatric kidney transplantation access and related outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study of children &lt;18 years of age active on the kidney transplant list from 2008 to 2019 using the Scientific Registry of Transplant Recipients. Log-logistic accelerated failure time models were used to determine the time from first activation on the transplant list and the time on dialysis to deceased donor transplant, each with KAS era or race and ethnicity as the exposure of interest. We used logistic regression to assess odds of delayed graft function. Log-rank tests assessed time to graft loss within racial and ethnic groups across KAS eras.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All children experienced longer wait times from activation to transplantation post-KAS. In univariable analysis, Black and Hispanic children and other children of color experienced longer times from activation to transplant compared with White children in both eras; this finding was largely attenuated after multivariable analysis (time ratio, 1.16; 95% confidence interval, 1.01 to 1.32; time ratio, 1.13; 95% confidence interval, 1.00 to 1.28; and time ratio, 1.17; 95% confidence interval, 0.96 to 1.41 post-KAS, respectively). Multivariable analysis also showed that racial and ethnic disparities in time from dialysis initiation to transplantation in the pre-KAS era were mitigated in the post-KAS era. There were no disparities in odds of delayed graft function. Black and Hispanic children experienced longer times with a functioning graft in the post-KAS era.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>No racial and ethnic disparities from activation to deceased donor transplantation were seen before or after implementation of the KAS in multivariable analysis, whereas time on dialysis to transplantation and odds of short-term graft loss improved in equity after the implementation of the KAS, without compromising disparities in delayed graft function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Podcast<\/jats:title>\n                    <jats:p>This article contains a podcast at https:\/\/www.asn-online.org\/media\/podcast\/CJASN\/2021_12_07_CJN06740521.mp3<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.06740521","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T18:25:21Z","timestamp":1634754321000},"page":"1862-1871","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":20,"title":["Racial Disparities in Pediatric Kidney Transplantation under the New Kidney Allocation System in the United States"],"prefix":"10.2215","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3857-2536","authenticated-orcid":false,"given":"Jill R.","family":"Krissberg","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Department of Nephrology, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9947-936X","authenticated-orcid":false,"given":"Matthew B.","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anshal","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eran","family":"Bendavid","sequence":"additional","affiliation":[{"name":"Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Stedman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0542-8749","authenticated-orcid":false,"given":"Xingxing S.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane C.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7870-8592","authenticated-orcid":false,"given":"Paul C.","family":"Grimm","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Nephrology, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abanti","family":"Chaudhuri","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Nephrology, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,12]]},"reference":[{"key":"B1-20241015","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1007\/s00467-016-3530-2","article-title":"Racial-ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients","volume":"32","author":"Laster","year":"2017","journal-title":"Pediatr Nephrol"},{"key":"B2-20241015","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1542\/peds.106.4.756","article-title":"Racial differences in access to the kidney transplant waiting list for children and adolescents with end-stage renal disease","volume":"106","author":"Furth","year":"2000","journal-title":"Pediatrics"},{"key":"B3-20241015","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1046\/j.1523-1755.2003.00788.x","article-title":"A prospective cohort study of incident maintenance dialysis in children: An NAPRTC study","volume":"63","author":"Leonard","year":"2003","journal-title":"Kidney Int"},{"key":"B4-20241015","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1111\/petr.12569","article-title":"Pediatric deceased donor renal transplantation: An approach to decision making. 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Pediatric kidney allocation in the USA: The old and the new","volume":"19","author":"Chaudhuri","year":"2015","journal-title":"Pediatr Transplant"},{"key":"B5-20241015","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1111\/ajt.14663","article-title":"Decreasing deceased donor transplant rates among children (\u22646 years) under the new kidney allocation system","volume":"18","author":"Shelton","year":"2018","journal-title":"Am J Transplant"},{"key":"B6-20241015","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1007\/s40615-018-0464-3","article-title":"Evolving trends in racial disparities for peri-operative outcomes with the new kidney allocation System (KAS) implementation","volume":"5","author":"Sanchez","year":"2018","journal-title":"J Racial Ethn Health Disparities"},{"key":"B7-20241015","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1377\/hlthaff.2016.1625","article-title":"New kidney allocation system associated with increased rates of 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