WIP 59 - Understanding Barriers to Living Donor Kidney Transplantation in Children: A Mixed-Methods Study

Publication Number: WIP 59.7560

Stephanie P. Kerkvliet, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Elena C. Park, Geisinger Commonwealth School of Medicine, King of Prussia, PA, United States; Janet A. Deatrick, University of Pennsylvania School of Nur, Philadelphia, PA, United States; SANDRA AMARAL, CHOP, PHILADELPHIA, PA, United States

Background: Living donor kidney transplant (LDKT) has superior outcomes compared to deceased donor transplant. Social determinants of health (SDOH), including preferred language, impact access to LDKT because children must have eligible donors who understand and can navigate the transplant donor process. Characterizing SDOH-related barriers to LDKT for children is essential to inform targeted interventions that promote equity in LDKT.

Objective: Our study seeks to compare LDKT access between caregivers of children with end-stage kidney disease who speak primarily English versus those who speak languages other than English (LOE) and to discover intrapersonal, interpersonal, organizational, community and policy-related barriers and promoters of LDKT.

Design/Methods: Mixed methods analysis will explore barriers and promoters to LDKT. First, disparities in receipt of LDKT will be examined through semi-structured interviews of caregivers of children with kidney disease referred for transplant. Participants will be purposively sampled to compare caregivers who prefer English and those who prefer LOE (n~20/group). Interviews will also be conducted with key informants from the transplant clinical team (n~20). Transcripts will be coded by at least two investigators to identify barriers and promoters of LDKT.

Second, retrospective chart review will be conducted to examine clinical and demographic data of pediatric kidney transplant recipients at a single institution over the past 5 years (n~93). We will compare differences in LDKT receipt by clinical and demographic variables using descriptive statistics. We will then compare the quantitative data with the themes identified in interviews to identify consistent and disparate barriers and promoters to LDKT. These data will inform a future targeted intervention to reduce inequities in LDKT access.

This study has IRB approval. Approximately 70% of chart reviews are complete, and 30% will be completed by 1/2025. 10% of interviews are complete and a preliminary code book is developed. Interviews and qualitative analyses will be complete by 4/2025.