title: Racial disparities in access to pediatric kidney transplantation since share 35.
abstract: Share 35 was enacted in 2005 to shorten transplant wait times and provide high-quality donors to children with ESRD. To investigate the possible effect of this policy on racial disparities in access to pediatric transplantation, we analyzed data from the US Renal Data System before and after Share 35. Among 4766 pediatric patients with incident ESRD, the probability of receiving a deceased-donor kidney transplant increased 46% after Share 35, with Hispanics experiencing the greatest improvements (increases of 81% for Hispanics, 45% for blacks, and 37% for whites). On average, patients received a deceased-donor kidney transplant earlier after Share 35, but this finding varied by race: 63 days earlier for whites, 90 days earlier for blacks, and 201 days earlier for Hispanics. Furthermore, a shift from living- to deceased-donor sources occurred with Share 35 for all races, with a 25% reduction in living donors for whites compared with 48% and 46% reductions for Hispanics and blacks, respectively. In summary, Share 35 seems to have attenuated racial disparities in the time to and probability of children receiving a deceased-donor kidney transplant. These changes coincided with changes in the rates of living-donor sources, which vary by race. Future studies should explore how these changes may impact racial differences in long-term graft outcomes.
authors.affiliation: Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. amarals@email.chop.edu
authors.forename: Sandra
authors.initials: S
authors.lastname: Amaral
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.forename: Nancy
authors.initials: N
authors.lastname: Kutner
authors.forename: William
authors.initials: W
authors.lastname: McClellan
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology* / Q000601:surgery; D016030:Kidney Transplantation / Q000208:ethnology* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D020380:Needs Assessment; D044469:Racial Groups / Q000706:statistics & numerical data*; D018570:Risk Assessment; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence; D014481:United States; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data