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Comparative Study
. 2013 Jul;13(7):1769-81.
doi: 10.1111/ajt.12299. Epub 2013 Jun 3.

Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States

R E Patzer  1 , B A Sayed, N Kutner, W M McClellan, S Amaral
Affiliations
Comparative Study

Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States

R E Patzer et al. Am J Transplant. 2013 Jul.

Abstract

Preemptive kidney transplantation is the optimal treatment for pediatric end stage renal disease patients to avoid increased morbidity and mortality associated with dialysis. It is unknown how race/ethnicity and poverty influence preemptive transplant access in pediatric. We examined the incidence of living donor or deceased donor preemptive transplantation among all black, white, and Hispanic children (<18 years) in the United States Renal Data System from 2000 to 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 versus whites. Blacks were 22% less likely to receive a DD preemptive transplant versus 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.

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Figures

Figure 1
Figure 1
The incidence of living donor (LD) and deceased donor (DD) preemptive transplantation among pediatric ESRD patients varied significantly over time, with a significant decrease in the incidence of LD preemptive transplant (p=0.0003) and a significant increase in DD preemptive transplant (p<0.0001) over the last decade (2000–2009).
Figure 2
Figure 2
The overall incidence of living donor (Panel A) preemptive transplant significantly declined among whites (p<0.0001), but remained stable among Hispanics (p=0.8546) and blacks (p=0.2800). The incidence of deceased donor (Panel B) preemptive transplant increased significantly among whites (p=0.0044) and Hispanics (p=0.0080), but not blacks (p=0.5815).
Figure 3
Figure 3
Across all types of health insurance coverage, white pediatric ESRD patients had a higher incidence rate of a living donor (LD) preemptive kidney transplant (Panel A) and a deceased donor (DD) preemptive kidney transplant (Panel B) compared to Hispanics and blacks.
Figure 3
Figure 3
Across all types of health insurance coverage, white pediatric ESRD patients had a higher incidence rate of a living donor (LD) preemptive kidney transplant (Panel A) and a deceased donor (DD) preemptive kidney transplant (Panel B) compared to Hispanics and blacks.
See this image and copyright information in PMC

References

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