Racial differences in access to the kidney transplant waiting list for children and adolescents with end-stage renal disease.
BACKGROUND
Renal transplantation is the treatment of choice for pediatric patients with end-stage renal disease (ESRD). Black patients wait longer for kidney transplants than do white patients.


OBJECTIVE
To determine whether the increased time to transplantation for black pediatric patients is attributable not only to a shortage of suitable donor organs, but also to racial differences in the time from a child's first treatment for ESRD until activation on the cadaveric kidney transplant waitlist.


METHODS
National longitudinal cohort study.


METHODS
US Medicare-eligible, pediatric ESRD population.


METHODS
Children and adolescents </=19 years old at the time of their first dialysis for ESRD between 1988 and 1993, followed through 1996. Patients who received living donor renal transplants were excluded from study.


METHODS
Time from first dialysis for ESRD until activation on the kidney transplant waiting list, relative hazard of activation on the waiting list for black compared with white pediatric patients.


RESULTS
Comparisons of the time from first dialysis for ESRD to waitlisting among the 2162 white (60.7%) and 1122 black (31.5%) patients studied using survival analysis revealed that blacks were less likely to be waitlisted at any given time in follow-up. In multivariate analysis, even after controlling for patient age, gender, socioeconomic status, geographic region, incident year of renal failure, and cause of ESRD, blacks were 12% less likely to be waitlisted than were whites at any point in time (relative hazard:. 88: 95% confidence interval:.79-.97).


CONCLUSIONS
Racial disparities in access to the renal transplant waiting list exist in pediatrics. Whether these disparities are attributable to differences in time of presentation to a nephrologist, physician bias in identification of transplant candidates, or patient preferences warrants further study.
Furth
S L
SL
Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. sfurth@jhmi.edu
Garg
P P
PP
Neu
A M
AM
Hwang
W
W
Fivush
B A
BA
Powe
N R
NR
D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D044383:Black People; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology*; D016030:Kidney Transplantation; D008297:Male; D016016:Proportional Hazards Models; D012737:Sex Factors; D012923:Social Class; D014850:Waiting Lists; D044465:White People