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Racial disparities in paediatric kidney transplantation

Blair S Grace1, Sean E Kennedy, Philip A Clayton

  • 1Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Level 9, East Wing, Royal Adelaide Hospital, Adelaide, South Australia, Australia, blair@anzdata.org.au.

Pediatric Nephrology (Berlin, Germany)
|August 10, 2013
PubMed

Insights

Caucasian children with end-stage kidney disease (ESKD) are more likely to receive optimal kidney transplants. Disparities exist in live donor transplantation, requiring further investigation to address barriers for minority groups.

Area of Science:

  • Paediatric Nephrology
  • Transplant Immunology
  • Health Disparities Research

Background:

  • Kidney transplantation is the leading treatment for pediatric end-stage kidney disease (ESKD).
  • Pre-emptive transplants from live donors with minimal human leukocyte antigen (HLA) mismatches offer superior outcomes.
  • Existing research has not fully differentiated transplant types when examining disparities in pediatric transplantation.

Purpose of the Study:

  • To investigate disparities in kidney transplant types among pediatric patients with ESKD.
  • To analyze differences in transplant outcomes based on patient race and donor type.

Main Methods:

  • Retrospective cohort study of 823 Australian pediatric patients (<18 years) initiating renal replacement therapy (RRT) between 1990-2011.
  • Data sourced from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).
  • Primary outcomes: time to first kidney transplant and donor type (deceased vs. living), analyzed using competing risk regression.

Main Results:

  • Caucasian children had the highest likelihood of receiving any transplant, primarily due to higher rates of live donor transplantation.
  • No Indigenous children received a pre-emptive transplant; they were significantly less likely to receive live donor transplants (SHR 0.41).
  • Caucasian recipients experienced fewer HLA mismatches, lower sensitization, and were more often diagnosed with slowly progressing or early-detectable kidney diseases.

Conclusions:

  • Paediatric Caucasian patients disproportionately receive optimal kidney transplants, characterized by live donors and fewer HLA mismatches.
  • Significant barriers to live donor transplantation exist for minority racial groups, particularly Indigenous children.
  • Further research is crucial to identify and mitigate these barriers to ensure equitable access to optimal transplantation for all children.
Abstract

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