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

R E Patzer1, B A Sayed, N Kutner

  • 1Department of Surgery, Emory Transplant Center, Emory University, Atlanta, GA, USA. rpatzer@emory.edu

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|June 5, 2013
PubMed

Insights

Racial and ethnic minorities, particularly Black and Hispanic children, face significant disparities in accessing preemptive kidney transplants. Poverty exacerbates these inequities, highlighting the need for improved pre-transplant care and living donation support.

Area of Science:

  • Pediatric Nephrology
  • Transplantation Immunology
  • Health Equity Research

Background:

  • Preemptive kidney transplantation is the preferred treatment for pediatric end-stage renal disease (ESRD), reducing dialysis-related complications.
  • Limited data exists on how race/ethnicity and socioeconomic factors impact preemptive transplant access in children.

Purpose of the Study:

  • To investigate racial/ethnic and poverty-related disparities in preemptive kidney transplant (living donor and deceased donor) access among US children.
  • To analyze the influence of health insurance and neighborhood poverty on preemptive transplant rates.

Main Methods:

  • Analysis of the United States Renal Data System (USRDS) from 2000-2009, including 8,053 pediatric patients (<18 years).
  • Examined incidence of preemptive transplantation stratified by race/ethnicity (Black, White, Hispanic).
  • Multivariable models calculated adjusted risk ratios (RR) for preemptive transplant access across insurance and poverty levels.

Main Results:

  • Overall, 13.9% of pediatric patients received a preemptive transplant (66.9% living donor, 33.1% deceased donor).
  • Significant disparities observed in living donor preemptive transplants: Black children were 66% less likely (RR=0.34) and Hispanic children 52% less likely (RR=0.48) than White children.
  • Black children showed a non-significant trend towards lower deceased donor preemptive transplant access (RR=0.78).

Conclusions:

  • Substantial racial/ethnic disparities exist in accessing preemptive kidney transplants for children, particularly for living donor organs.
  • Poverty and associated barriers likely contribute to these inequities, underscoring the need for improved access to pre-ESRD care and living donation support.
  • Future interventions must address socioeconomic and racial barriers to promote equitable preemptive transplant access in pediatric ESRD patients.

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