Pediatric kidney transplant disparities

Kidney transplantation (KT) is essential for end-stage renal disease, significantly improving survival and quality of life. Yet, in pediatric renal disease management, minority children face poorer dialysis outcomes and reduced access to transplantation.

To identify and understand these differences in the pediatric population.

Using ICD-10 codes, we queried the 2022 Health Care Cost and Use Project Kid's Inpatient Database for admissions with a primary or secondary diagnosis of severe chronic kidney disease (sCKD), namely stages 4 and 5, or a KT procedure. Patient demographics, insurance types, and hospital stay metrics were assessed through statistical analyses including Wilcoxon Rank Sum, χ ², and logistic regression.

A total of 636 hospital admissions related to KT surgery and 3733 hospital admissions with sCKD as the primary diagnosis were identified. In both the KT and sCKD cohorts, most patients were White (42.6% vs 36.6%), male (59.8% in both groups), aged 12-18 years (57.9% vs 50.3%), and insured by Medicaid (35.7% vs 43.0%). KT and sCKD hospitalizations were uncommon among infants aged 0-1 year (1.6% and 9.9%, respectively). Analysis of income quartiles based on patients' residential zip codes demonstrated no significant differences between those who underwent KT and those with sCKD without transplant. Although mortality rates did not differ statistically between groups, a numerical difference was observed, with higher mortality in the sCKD cohort compared to the KT cohort (16 deaths vs 4 deaths).After adjusting for socioeconomic and geographic factors, Black race was independently associated with lower odds of undergoing KT (adjusted odds ratio 0.69; 95% confidence interval: 0.53-0.89).

Pediatric KT recipients were more likely to be male, White, and aged 12-18 years. Racial disparities persist, with ethnic minority groups-particularly Black patients-facing reduced access to KT. These findings underscore the necessity of implementing targeted interventions to promote equitable access to pediatric KT.