title: Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States.
abstract: Preemptive kidney transplantation is the optimal treatment for pediatric end stage renal disease patients to avoid increased morbidity and mortality associated with dialysis. It is unknown how race/ethnicity and poverty influence preemptive transplant access in pediatric. We examined the incidence of living donor or deceased donor preemptive transplantation among all black, white, and Hispanic children (<18 years) in the United States Renal Data System from 2000 to 2009. Adjusted risk ratios for preemptive transplant were calculated using multivariable-adjusted models and examined across health insurance and neighborhood poverty levels. Among 8,053 patients, 1117 (13.9%) received a preemptive transplant (66.9% from LD, 33.1% from DD). In multivariable analyses, there were significant racial/ethnic disparities in access to LD preemptive transplant where blacks were 66% (RR = 0.34; 95% CI: 0.28-0.43) and Hispanics 52% (RR = 0.48; 95% CI: 0.35-0.67) less likely to receive a LD preemptive transplant versus whites. Blacks were 22% less likely to receive a DD preemptive transplant versus whites (RR = 0.78, 95% CI: 0.57-1.05), although results were not statistically significant. Future efforts to promote equity in preemptive transplant should address the critical issues of improving access to pre-ESRD nephrology care and overcoming barriers in living donation, including obstacles partially driven by poverty.
authors.affiliation: Department of Surgery, Emory Transplant Center, Emory University, Atlanta, GA, USA. rpatzer@emory.edu
authors.forename: R E
authors.initials: RE
authors.lastname: Patzer
authors.forename: B A
authors.initials: BA
authors.lastname: Sayed
authors.forename: N
authors.initials: N
authors.lastname: Kutner
authors.forename: W M
authors.initials: WM
authors.lastname: McClellan
authors.forename: S
authors.initials: S
authors.lastname: Amaral
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000601:surgery; D016030:Kidney Transplantation / Q000208:ethnology*; D019520:Living Donors; D008297:Male; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists