Inequality in pediatric kidney transplantation in Brazil.
BACKGROUND
The aim of this study was to describe the access and factors associated with kidney transplantation for children in different regions of Brazil.


METHODS
We analyzed a cohort of 1211 children enrolled on the transplant list from January 2011 to December of 2013. We fitted regression models to investigate factors associated with: (a) undergoing kidney transplantation from a deceased donor, and (b) being removed from the waiting list.


RESULTS
The incidence of transplantation was uneven across regions, with the lowest rate at 0.4 per million age-related population (pmarp) in the Midwest and the highest incidence rate of 8.3 cases pmarp in the South. Children from the North and the Midwest regions had a 3-4 times lower probability of undergoing a deceased donor transplant (p < 0.05). Apart from the geographic region, age of recipients and GDP influenced the outcome. The likelihood of undergoing transplantation was very low in the youngest children in the North and Midwest. The number of transplant centers was not associated with either outcome.


CONCLUSIONS
Factors of inequality in transplantation in Brazil are of macroeconomic origin, but there is room to reduce inequalities. Training existing transplant center professionals in the care of children could diminish the discrepancies.
Pediatric Renal Transplant Service, Hospital Samaritano de São Paulo, Sao Paulo, Sao Paulo, Brazil. pkoch.dped@epm.br.|Pediatrics Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Sao Paulo, Brazil. pkoch.dped@epm.br.
Paulo Cesar Koch
PC
Nogueira
Pediatric Renal Transplant Service, Hospital Samaritano de São Paulo, Sao Paulo, Sao Paulo, Brazil.
Maria Fernanda Camargo
MF
de Carvalho
Pediatric Renal Transplant Service, Hospital Samaritano de São Paulo, Sao Paulo, Sao Paulo, Brazil.|Pediatrics Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Sao Paulo, Brazil.
Luciana
L
de Santis Feltran
Pediatrics Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Sao Paulo, Brazil.
Tulio
T
Konstantyner
Nephrology Department, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Sao Paulo, Brazil.
Ricardo
R
Sesso
D000293:Adolescent; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D020380:Needs Assessment; D017064:Process Assessment, Health Care; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome; D014850:Waiting Lists
Demography; Epidemiology; Kidney transplantation; Pediatrics; Supply and distribution