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Disparities, race/ethnicity and access to pediatric kidney transplantation
1aDepartment of Pediatrics, The Children's Hospital of Philadelphia bDepartment of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA cDepartment of Surgery, Emory Transplant Center, Emory University dDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Insights
Racial disparities in pediatric kidney transplantation access persist, particularly for living donors. Addressing socioeconomic factors and ensuring equitable healthcare access are crucial for improving transplant equity in children.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Health Equity Research
Background:
- Kidney transplantation is the preferred treatment for pediatric end-stage renal disease.
- Significant racial disparities exist in access to kidney transplants for Black children compared to White children in the U.S.
- The underlying causes of these disparities are not fully understood.
Purpose of the Study:
- To investigate the interplay of socioeconomic status, race, and access to pediatric kidney transplantation.
- To identify key factors contributing to disparities in transplant access.
- To inform strategies for improving equity in pediatric kidney transplant access.
Main Methods:
- Analysis of national data on pediatric kidney transplant recipients.
- Examination of disparities in access to living versus deceased donors.
- Assessment of the impact of insurance status and socioeconomic factors on transplant access.
Main Results:
- Disparities are more pronounced in access to living donor kidney transplants.
- National policies have reduced racial differences in deceased donor kidney transplant (DDKT) access post-waitlisting.
- Minority emerging adults face stark DDKT access disparities after losing pediatric priority.
- Disparities persist even after accounting for insurance and poverty, suggesting systemic issues.
Conclusions:
- Overcoming disparities requires a focus on the entire transplant process, including equitable healthcare access.
- Public health advocacy and national policies addressing socioeconomic factors are essential for achieving transplant equity.
- Addressing differential access to care and social structures is critical for improving pediatric transplant outcomes.
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.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:26Kidney Transplant II: Surgical Procedure
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption