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Updated: Mar 28, 2026
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Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
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Effect of Immigration Status on Outcomes in Pediatric Kidney Transplant Recipients
M E McEnhill1, J L Brennan1, E Winnicki2
1Division of Transplant, Department of Surgery, University of California, San Francisco, CA.
Summary
Kidney transplant outcomes in undocumented children are similar to citizens, but graft loss increases after age 21 due to insurance gaps. Policy changes are needed to ensure continued access to care for these pediatric patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Health Policy Research
Background:
- End-stage renal disease (ESRD) in children necessitates kidney transplantation.
- Access to transplantation and outcomes data for undocumented children are limited.
- This study addresses disparities in pediatric kidney transplant care.
Purpose of the Study:
- To compare kidney transplant outcomes between undocumented and US citizen children.
- To identify factors influencing graft survival and function in these populations.
- To inform policy recommendations for improving care for undocumented pediatric transplant recipients.
Main Methods:
- Retrospective, single-center study of 289 pediatric kidney transplant recipients (1998-2010).
- Identified 48 (17%) undocumented children.
- Compared graft survival, estimated glomerular filtration rate (eGFR), and allograft failure rates between groups, adjusting for covariates.
Main Results:
- Graft survival at 1 and 5 years post-transplantation was similar between undocumented and citizen children.
- Mean eGFR at 1 year was higher in undocumented recipients.
- Lower risk of allograft failure at 5 years in undocumented recipients (adjusted p < 0.04).
- Nearly 20% of undocumented recipients lost grafts after age 21 due to loss of insurance and inability to afford immunosuppression.
Conclusions:
- Undocumented children experience comparable short-term kidney transplant outcomes to citizens.
- Loss of state-funded insurance post-age 21 poses a significant risk for graft loss in undocumented recipients.
- Policy interventions facilitating work permits and employment-related insurance are crucial for long-term graft survival in this vulnerable population.
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