09/18/2026
Riley Children’s Health physician-scientist Marciana L. Laster, MD, is leading a National Institutes of Health (NIH) R01 grant-funded study to identify barriers to ensuring adolescent candidates for kidney transplant are added to the transplant waiting list before age 18.
The study, which uses nationally recognized expertise and data science resources from the Regenstrief Institute in Indiana, is designed to address a common issue in improving access to kidney transplantation for children and adolescents—missed pediatric priority. Adolescents who miss their priority status wait three times as long for a transplant, resulting in more time on dialysis.
“Our preliminary data shows that 24% of children on dialysis miss their priority despite starting dialysis a median of 2.5 years before their 18th birthday,” said Dr. Laster, assistant professor of pediatrics at Indiana University School of Medicine, and a specialist in complex kidney disease. “While there are likely many reasons for the delay, I suspect we’ll find that the vast differences in how pediatric centers across the country handle waitlisting and the lack of a national standard for when children should be waitlisted may be significant contributors.”
To uncover the reasons for missed priority, Dr. Laster will use the Early Steps to Transplant Access Registry (E-STAR), a proven surveillance data registry platform developed by leading transplantation researcher and Regenstrief Institute CEO Rachel Patzer, PhD, MPH, a co-investigator on Dr. Laster’s R01 study. Data will be gathered from five major pediatric health centers—Riley Children’s Health, Cincinnati Children’s Hospital, Nationwide Children’s Hospital, Children’s Healthcare of Atlanta and UNC Children’s Hospital. The information collected will focus on characterizing pre-waitlisting steps and determining the risk factors for missed priority.
“We will be zeroing in on the steps prior to waitlisting to see how we can best intervene to help kids get the priority status they need to get to transplant sooner,” explained Dr. Laster. “Is the problem with referral, issues with getting patients into the transplant clinics post-referral or are there other barriers along the pathway—these are the types of holistic questions we aim to answer with this study.”
With plans to expand data collection beyond the initial five centers, Dr. Laster is hopeful the study results will serve as a foundation for future discussion about the best ways to address missed priority in pediatric kidney transplant.
“A lot of my work will involve networking with pediatric centers and encouraging more to sign up to contribute data because we know that centers get patients to the waitlist differently,” Dr. Laster said. “My hope is that this research will eventually lead to a consensus conference, bringing pediatric transplant centers together to discuss standardized guidelines for kidney transplant waitlisting.”
In addition to this R01-funded research, in 2020 Dr. Laster received a five-year NIH K23 award examining the role of Vitamin D genetics and racial differences in pediatric chronic kidney disease-mineral and bone disorder (CKD-MBD). As a follow-up, she is using an NIH R03 grant, awarded in 2025, to investigate the individual and community-level contributors to Vitamin D deficiency in pediatric chronic kidney disease.
Riley Children’s is home to a comprehensive multidisciplinary pediatric kidney transplant program incorporating nephrology, pediatrics and internal medicine, adolescent medicine, and psychology. The pediatric health system has served as a study site for Chronic Kidney Disease in Children (CKiD), funded by the NIH, since 2005.
Learn more
Check out Nephrology section of the latest Riley Children’s Health annual report for more information about treatment, novel programs and research.
