Abstract
BACKGROUND: Understanding disparities in pediatric kidney transplants is important to provide equitable care. We compared transplant outcomes between English-speaking (ES) and interpreter-needing (IN) pediatric kidney transplant recipients.
METHODS: Through retrospective review, primary kidney transplant recipients, 0-21 years transplanted between 2005 and 2019, were divided into ES and IN cohorts. Continuous and categorical variables were compared using Wilcoxon rank-sum, Welch two-sample t-test, and chi-squared analyses. Patient survival, graft survival, and rejection-free survival were evaluated using Kaplan-Meier methods and Cox regression. Days hospitalized were evaluated using negative binomial regression.
RESULTS: Our sample included 211 ES and 37 IN transplant recipients. Compared with the ES, the IN cohort was older at transplant (14.56 vs. 11.03 years; p < 0.01), had more time between kidney failure and transplant (0.9 vs. 0.3 years; p < 0.01), and more often received deceased over living donor transplants (78.4% vs. 30.4%; p < 0.01). Multivariate Cox proportional-hazard models evaluating adjusted 5-year patient survival demonstrated decreased 5-year post-transplant survival in the IN cohort (aHR = 10.10, 95% CI: 1.5, 66.8; p = 0.02). We did not identify differences in 5-year death-censored graft survival (aHR = 0.57; 95% CI: 0.14, 2.4; p = 0.4) nor rejection-free survival (aHR = 0.8; 95% CI: 0.4, 1.5; p = 0.5). We found significantly fewer hospitalization events in the IN cohort during the first year post-transplant (aRR: 0.62; 95% CI: 0.4, 0.9; p = 0.01) but no difference 5-year post-transplant. The IN cohort had more missed outpatient appointments (10.4% vs. 2.8%; p = 0.03) and undetectable serum immunosuppressant levels (mean: 3.8% vs. 1.3%; p = 0.02) 5 years post-transplant.
CONCLUSIONS: Pediatric kidney transplant recipients requiring interpreter services for healthcare delivery demonstrate fewer post-transplant interactions with their healthcare team (fewer hospitalizations and more no-show visits) and lower 5-year patient survival compared with recipients not requiring interpreters. A higher resolution version of the Graphical abstract is available as Supplementary information.
Original language | English (US) |
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Pages (from-to) | 2209-2219 |
Number of pages | 11 |
Journal | Pediatric Nephrology |
Volume | 38 |
Issue number | 7 |
DOIs | |
State | Published - Jul 2023 |
Bibliographical note
Funding Information:This work was, in part, supported by the Cancer Biology Training Grant of the University of Minnesota (T32 CA009138; C.P.K.), Medical Scientist Training Program (T32 GM008244; C.P.K.), and the F30 CA228261 (C.P.K.). This research was also supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to International Pediatric Nephrology Association.
Keywords
- Interpreter
- Kidney transplant
- Language barrier
- Limited English proficiency
- Pediatric
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Extramural