Association between residence location and likelihood of transplantation among pediatric dialysis patients

Abstract

Many children with ESRD reside far from a kidney transplant center. It is unknown whether this geographical barrier affects likelihood of transplantation. We used data from a national ESRD database. Patients ≤ 18 yr old who started renal replacement in nine Canadian provinces during 1992-2007 were followed until death or last contact. Primary outcome was kidney transplantation (living or deceased donor). Distance between nearest pediatric transplant center and each patient's residence was categorized as: <50, 50 to <150, 150 to <300, and ≥ 300 km. Using survival analysis, we compared likelihood of transplantation between whites and non-whites living in various distance categories. Among 728 patients, 52.2% were males and 62.5% were whites. Compared to white children living < 50 km from a transplant center, white (HR, 0.73; 95% CI, 0.56-0.95) and non-white (HR, 0.66; 95% CI, 0.48-0.92) children living ≥ 300 km away were less likely to receive a transplant. Non-white children living < 50 km away (HR, 0.59; 95% CI 0, 45-0.78) were also less likely to receive a transplant compared to otherwise similar whites living < 50 km away. Although equitable access to transplantation by residence location is observed among remote-dwelling adults with ESRD, white and non-white children with ESRD living ≥ 300 km from a transplant center were less likely to receive transplants.