title: Disparities, race/ethnicity and access to pediatric kidney transplantation.
abstract: OBJECTIVE
  Kidney transplantation remains the optimal treatment for children with end-stage renal disease; yet, in the United States, profound differences in access to transplant persist, with black children experiencing significantly reduced access to transplant compared with white children. The reasons for these disparities remain poorly understood. Several recent studies provide new insights into the interplay of socioeconomic status, racial/ethnic disparities and access to pediatric kidney transplantation.
  
  
  RESULTS
  New evidence suggests that disparities are more pronounced in access to living vs. deceased donors. National allocation policies have mitigated racial differences in pediatric deceased donor kidney transplant (DDKT) access after waitlisting. However, disparities in access to DDKT are stark for minority emerging adults, who lose pediatric priority allocation. Although absence of health insurance poses an important barrier to transplant, even after adjustment for insurance status and neighborhood poverty, disparities persist. Differential access to care and unjust social structures are posited as important modifiable barriers to achieving equity in pediatric transplant access.
  
  
  CONCLUSIONS
  Future approaches to overcome disparities in pediatric kidney transplant access must focus on the continuum of the transplant process, including equitable health care access. Public health advocacy efforts to promote national policies that address disparate multilevel socioeconomic factors are essential.
authors.affiliation: aDepartment of Pediatrics, The Children's Hospital of Philadelphia bDepartment of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA cDepartment of Surgery, Emory Transplant Center, Emory University dDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Amaral
authors.forename: Rachel
authors.initials: R
authors.lastname: Patzer
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003466:Cultural Characteristics; D005006:Ethnicity; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery*; D016030:Kidney Transplantation; D019520:Living Donors; D008913:Minority Groups; D012931:Social Environment; D012959:Socioeconomic Factors; D009927:Tissue and Organ Procurement; D014481:United States / Q000453:epidemiology