Disparities, race/ethnicity and access to pediatric kidney transplantation

• Type of Material: Article
• Authors: Sandra Amaral, University of Pennsylvania; Rachel Patzer, Emory University
• Language: English
• Date: 2013-05-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © Lippincott Williams & Wilkins.
• Final Published Version (URL): http://dx.doi.org/10.1097/MNH.0b013e32835fe55b
• Title of Journal or Parent Work: Current Opinion in Nephrology and Hypertension
• ISSN: 1062-4821
• Volume: 22
• Issue: 3
• Start Page: 336
• End Page: 343
• Grant/Funding Information: S.A. is supported by funding from the National Institute of Diabetes and Digestive and Kidney Diseases 1K23DK083529–01A2.; R.E.P. is supported in part by grants from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number ULl TR000454 and KL2TR0004SS as well as a grant from the National Institute on Minority Health and Health Disparities under award number 1R24MD008077-01.
• Keywords: IMPACT; disparities; CHILDREN; Life Sciences & Biomedicine; transplant; Science & Technology; STAGE RENAL-DISEASE; SOCIOECONOMIC-STATUS; Cardiovascular System & Cardiology; COMPLETION; DIALYSIS; Peripheral Vascular Disease; pediatric; HEALTH-CARE; RACIAL-DIFFERENCES; UNITED-STATES; Urology & Nephrology; RACE
• Research Categories: Health Sciences, Medicine and Surgery; Social Work; Health Sciences, Public Health

Abstract

Purpose of review: Kidney transplantation remains the optimal treatment for children with end-stage renal disease; yet, in the United States, profound differences in access to transplant persist, with black children experiencing significantly reduced access to transplant compared with white children. The reasons for these disparities remain poorly understood. Several recent studies provide new insights into the interplay of socioeconomic status, racial/ethnic disparities and access to pediatric kidney transplantation. Recent findings: New evidence suggests that disparities are more pronounced in access to living vs. deceased donors. National allocation policies have mitigated racial differences in pediatric deceased donor kidney transplant (DDKT) access after waitlisting. However, disparities in access to DDKT are stark for minority emerging adults, who lose pediatric priority allocation. Although absence of health insurance poses an important barrier to transplant, even after adjustment for insurance status and neighborhood poverty, disparities persist. Differential access to care and unjust social structures are posited as important modifiable barriers to achieving equity in pediatric transplant access. Summary: Future approaches to overcome disparities in pediatric kidney transplant access must focus on the continuum of the transplant process, including equitable health care access. Public health advocacy efforts to promote national policies that address disparate multilevel socioeconomic factors are essential.