Evaluation of the implementation of a “Pediatric Feasibility Assessment for Transplantation” tool in children and adolescents at Red Cross War Memorial Children's Hospital, Cape Town, South Africa

• Published in: Pediatric transplantation Vol. 28; no. 3; pp. e14709 - n/a
• Main Authors: Adetunji, Adewale E., Gajjar, Priya, Luyckx, Valerie A., Reddy, Deveshni, Collison, Nicolette, Abdo, Theresa, Pienaar, Taryn, Nourse, Peter, Coetzee, Ashton, Morrow, Brenda, McCulloch, Mignon I.
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.05.2024
• Subjects: Adolescent; Child; Children; CKD/KF; Dialysis; Feasibility Studies; Hospitals, Pediatric; Humans; kidney transplant; Kidney transplantation; Pediatrics; pFAT tool; Red Cross; Renal failure; Retrospective Studies; South Africa; Survival; transplant eligibility; Transplants & implants; South Africa; kidney transplant; transplant eligibility; CKD/KF; pFAT tool
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.14709

Background Kidney transplantation remains the treatment of choice for children with kidney failure (KF). In South Africa, kidney replacement therapy (KRT) is restricted to children eligible for transplantation. This study reports on the implementation of the Paediatric Feasibility Assessment for Transplantation (pFAT) tool, a psychosocial risk score developed in South Africa to support transparent transplant eligibility assessment in a low‐resource setting. Methods Single‐center retrospective descriptive analysis of children assessed for KRT using pFAT tool from 2015 to 2021. Results Using the pFAT form, 88 children (median [range] age 12.0 [1.1 to 19.0] years) were assessed for KRT. Thirty (34.1%) children were not listed for KRT, scoring poorly in all domains, and were referred for supportive palliative care. Fourteen of these 30 children (46.7%) died, with a median survival of 6 months without dialysis. Nine children were reassessed and two were subsequently listed. Residing >300 km from the hospital (p = .009) and having adherence concerns (p = .003) were independently associated with nonlisting. Of the 58 (65.9%) children listed for KRT, 40 (69.0%) were transplanted. One‐year patient and graft survival were 97.2% and 88.6%, respectively. Only one of the four grafts lost at 1‐year posttransplant was attributed to psychosocial issues. Conclusions Short‐term outcomes among children listed using the pFAT form are good. Among those nonlisted, the pFAT highlights specific psychosocial/socioeconomic barriers, over which most children themselves have no power to change, which should be systemically addressed to permit eligibility of more children and save lives. The pFAT form highlights factors most frequently leading to “non‐listing” for dialysis and transplantation. This tool enables early identification of potentially remediable barriers to transplantation, permitting targeted interventions to improve a child’s chance of being listed.