title: Racial and ethnic disparities in pediatric renal allograft survival in the United States.
abstract: This study was undertaken to describe the association of patient race/ethnicity and renal allograft survival among the national cohort of pediatric renal allograft recipients. Additionally, we determined whether racial and ethnic differences in graft survival exist among individuals living in low- or high-poverty neighborhoods and those with private or public insurance. Among 6216 incident, pediatric end-stage renal disease patients in the United States Renal Data System (kidney transplant from 2000 through September, 2011), 14.4% experienced graft failure, with a median follow-up time of 4.5 years. After controlling for multiple covariates, black race, but not Hispanic ethnicity, was significantly associated with a higher rate of graft failure for both deceased and living donor transplant recipients. Disparities were particularly stark by 5 years post transplant, when black living donor transplant recipients experienced only 63.0% graft survival compared with 82.8 and 80.8% for Hispanics and whites, respectively. These disparities persisted among high- and low-poverty neighborhoods and among both privately and publicly insured patients. Notably profound declines in both deceased and living donor graft survival rates for black, compared with white and Hispanic, children preceded the 3-year mark when transplant Medicare eligibility ends. Further research is needed to identify the unique barriers to long-term graft success among black pediatric transplant recipients.
authors.affiliation: 1] Department of Surgery, Division of Transplantation, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA [2] Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.affiliation: Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Sumit
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kutner
authors.affiliation: 1] Department of Surgery, Division of Transplantation, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA [2] Division of Nephrology, Emory University, Atlanta, Georgia, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
authors.affiliation: 1] Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Philadelphia, USA [2] Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Amaral
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D064591:Allografts; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000208:ethnology*; D006085:Graft Survival; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D011204:Poverty Areas; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*