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Author Notes:

Corresponding Author: Rachel E. Patzer, PhD, MPH, Emory University, Department of Surgery, Emory Transplant Center 101 Woodruff Circle, WMB 5125; Telephone: 404-727-6047; Email: rpatzer@emory.edu

The authors would like to acknowledge the assistance of the peer reviewers and editors of the AJT who thoughtfully read and commented on earlier drafts of this manuscript and added greatly to the final version.

The interpretation and reporting of the data presented here are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.


Research Funding:

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.


  • children
  • United States Renal Data System
  • racial disparity
  • epidemiology
  • health policy
  • pediatric kidney transplantation
  • preemptive

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


Journal Title:

American Journal of Transplantation


Volume 13, Number 7


, Pages 1769-1781

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2013 The American Society of Transplantation and the American Society of Transplant Surgeons

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