Racial and Ethnic Differences in Pediatric Access to Preemptive Kidney Transplantation in the United States

• Type of Material: Article
• Authors: Rachel Elizabeth Patzer, Emory University; Blayne A Sayed, Emory University; Nancy Kutner, Emory University; William McClellan, Emory University; Sandra Amaral, University of Pennsylvania
• Language: English
• Date: 2013-07
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 The American Society of Transplantation and the American Society of Transplant Surgeons
• Final Published Version (URL): http://onlinelibrary.wiley.com/doi/10.1111/ajt.12299/abstract;jsessionid=3AD01DD08DCC828C1552ABC42E567204.f02t04
• Title of Journal or Parent Work: American Journal of Transplantation
• ISSN: 1600-6135
• Volume: 13
• Issue: 7
• Start Page: 1769
• End Page: 1781
• Grant/Funding Information: R.E.P. was 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 KL2TR000455 as well as 1R24MD008077-01 through the National Institute on Minority Health and Health Disparities.; S.A. is supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases K23-DK083529-01A2.
• Keywords: pediatric kidney transplantation; epidemiology; health policy; United States Renal Data System; racial disparity; preemptive; children
• Research Categories: Health Sciences, Public Health; Health Sciences, General; Sociology, Ethnic and Racial Studies

Abstract

Preemptive kidney transplantation is the optimal treatment for pediatric End Stage Renal Disease (ESRD) patients to avoid increased morbidity and mortality associated with dialysis. It is unknown how race/ethnicity and poverty influence preemptive transplant access in pediatric ESRD. We examined the incidence of living donor (LD) or deceased donor (DD) preemptive transplantation among all black, white, and Hispanic children (< 18 years) in the United States Renal Data System from 2000–2009. Adjusted risk ratios for preemptive transplant were calculated using multivariable-adjusted models and examined across health insurance and neighborhood poverty levels. Among 8,053 patients, 1117 (13.9%) received a preemptive transplant (66.9% from LD, 33.1% from DD). In multivariable analyses, there were significant racial/ethnic disparities in access to LD preemptive transplant where blacks were 66% (RR=0.34; 95% CI: 0.28–0.43) and Hispanics 52% (RR=0.48; 95% CI: 0.35–0.67) less likely to receive a LD preemptive transplant vs. whites. Blacks were 22% less likely to receive a DD preemptive transplant vs. whites (RR=0.78, 95% CI: 0.57–1.05) although results were not statistically significant. Future efforts to promote equity in preemptive transplant should address the critical issues of improving access to pre-ESRD nephrology care and overcoming barriers in living donation, including obstacles partially driven by poverty.