Abstract
Background: Kidney transplantation is the preferred treatment modality for children with end-stage renal disease. In the adult population, migration-related modifiable factors were associated with low living donation rates; no such data are available on the pediatric population. This pilot study therefore compares donation modality, communication, knowledge, and attitudes/beliefs between families of immigrant and non-immigrant descent.Methods: Demographic and clinical characteristics of a cohort of children from 77 families of immigrant (32; 42%) and non-immigrant (45; 58%) descent who had undergone renal transplantation were assessed and related to donation modality at the Medical University of Vienna. In a representative subset, modifiable migration-related factors were assessed in a questionnaire-based study.Results: In immigrant families, information delay, limited communication, low knowledge levels, and self-reported conflicting beliefs were significantly more prevalent than in non-immigrants. The living kidney donation rate to children was high in both populations (immigrants: 63%, non-immigrants: 44%; p = 0.12). Living donation to children on dialysis was even significantly higher in immigrant families (immigrants: 13 out of 20; 57%, non-immigrants: 9 out of 33; 27%; p = 0.03).Conclusion: Contrary to expectations, migration-related disparities did not translate into decreased living donation rates in immigrant families, in particular to children on dialysis. Certain factors might therefore be less important for the living donation process in pediatric care structures and/or might be overcome by yet undefined protective factors. Larger pediatric studies including qualitative and quantitative methods are required to validate and refine current conceptual frameworks integrating the perspective of affected families.
Highlights
Kidney transplantation (KTx) is the treatment modality of choice in end-stage renal disease [1,2,3]
Recent research in the adult setting demonstrated that modifiable factors in the dimensions of communication, knowledge, and attitudes/beliefs are important in the living donation process [16]
There was no difference in the time from first referral to the start of renal replacement therapy (RRT), the waiting time from listing at Eurotransplant to KTx, or age at KTx (Table 1)
Summary
Kidney transplantation (KTx) is the treatment modality of choice in end-stage renal disease [1,2,3]. The same modifiable factors are likely to differ between immigrant and non-immigrant families, and might represent attractive targets to increase LD (and preemptive) KTx in that setting, thereby reducing disparities for children in immigrant families [4]. To the best of our knowledge, neither disparities in modifiable factors (used to build the “adult” psychosocial concept of LD) nor their actual clinical relevance in immigrant and non-immigrant families on donation modality have been assessed in the pediatric setting of KTx to date. Migration-related modifiable factors were associated with low living donation rates; no such data are available on the pediatric population. This pilot study compares donation modality, communication, knowledge, and attitudes/beliefs between families of immigrant and non-immigrant descent
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