Distance to Transplant Center Affects Follow-Up Care in Pediatric Transplant Recipients

Sierra Armstrong

Credit: LinkedIn

Transportation insecurity may pose a significant barrier to care and contribute to worse health outcomes and post-transplant follow-up care in pediatric transplant recipients, according to findings from a retrospective cohort study.

Presented at the American Society of Nephrology Kidney Week 2023, results showed greater distance to the transplant center was associated with more clinic cancellations, which investigators pointed out could cause delayed care resulting in negative effects on transplant health.¹

“Securing transportation, especially for healthcare access, isn’t necessarily as easy to come by as we think,” said Sierra Armstrong, of Wake Forest School of Medicine, in an interview with HCPLive Nephrology. “I think the fact that we found a significant association between living further from the transplant center and having a higher rate of clinic cancellations leaves a lot to the imagination as far as trying to understand what barriers could be at play in this population and what might be keeping them from healthcare access and being able to better maintain their transplant.”

Kidney transplants are necessary for patients experiencing kidney failure. Without dialysis or a transplant, the condition is fatal. Although kidney transplantation can offer patients a better quality of life and a longer life expectancy, the procedure’s long-term success is dependent upon adequate follow-up care.²

To assess the impact of distance to the transplant center on outcomes and post-transplant follow-up care in pediatric transplant recipients, Armstrong and colleagues extracted data from the electronic health records of patients 0-18 years of age who received a kidney transplant and received post-transplant care at Atrium Health Wake Forest Baptist Medical Center from September 25, 2012, to December 31, 2022. Patients who received multiple organ transplants and received post-transplant care at another center were excluded from the study.¹

Distance to the transplant center, determined by calculating geodetic distance from participants’ residence zip code to the transplant center, was used as the study exposure. Outcomes of interest included graft survival, biopsy-proven acute rejection, hospitalization rates, no-shows, and canceled appointments in the transplant clinic. Investigators used Kaplan-Meier curves and Cox proportional hazards regression to estimate associations of the exposure with outcomes.¹

In total, 78 patients were included in the study. Among the cohort 37% (n = 29) of participants were female, the median age at transplant was 8.5 (interquartile range [IQR], 3-14) years, the median follow-up was 5.0 (IQR, 1-7) years, and the median distance to the transplant center was 29.0 (IQR, 13.4-60.1) miles. The mean no-show proportion was 8.9% (Standard deviation [SD], 8.1%) and the mean cancellation proportion was 26.3% (SD, 10.6%).¹

Upon analysis, distance to the transplant center was not associated with an increased risk of graft failure, shorter time to first biopsy-proven acute rejection, greater biopsy-proven acute rejection, and increased hospitalization rates. However, investigators noted further distance from the transplant center was associated with a greater proportion of canceled clinic appointments (P <.001; Beta coefficient, 1.08 per 10 miles; 95% confidence interval, 0.63-1.54).¹

“We’re interested in looking more at qualitative data and interviewing patients to get more information from them about what they’re experiencing on a day-to-day basis that could be at play as far as not being able to maintain their appointments,” Armstrong concluded.

References:

1. Armstrong S, Russell GB, South AM, Chen A. Distance to Transplant Center and Pediatric Kidney Transplant Outcomes and Access to Care. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.
2. Cleveland Clinic. Kidney Transplant. Treatments & Procedures. March 14, 2022. Accessed November 4, 2023. https://my.clevelandclinic.org/health/treatments/22537-kidney-transplant