title: Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association) Registry.
abstract: BACKGROUND
  Racial disparities in kidney transplantation in children have been found in the United States, but have not been studied before in Europe.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Data were derived from the ESPN/ERA-EDTA Registry, an international pediatric renal registry collecting data from 36 European countries. This analysis included 1,134 young patients (aged ≤19 years) from 8 medium- to high-income countries who initiated renal replacement therapy (RRT) in 2006 to 2012.
  
  
  METHODS
  Racial background.
  
  
  METHODS
  Differences between racial groups in access to kidney transplantation, transplant survival, and overall survival on RRT were examined using Cox regression analysis while adjusting for age at RRT initiation, sex, and country of residence.
  
  
  RESULTS
  868 (76.5%) patients were white; 59 (5.2%), black; 116 (10.2%), Asian; and 91 (8.0%), from other racial groups. After a median follow-up of 2.8 (range, 0.1-3.0) years, we found that black (HR, 0.49; 95% CI, 0.34-0.72) and Asian (HR, 0.54; 95% CI, 0.41-0.71) patients were less likely to receive a kidney transplant than white patients. These disparities persisted after adjustment for primary renal disease. Transplant survival rates were similar across racial groups. Asian patients had higher overall mortality risk on RRT compared with white patients (HR, 2.50; 95% CI, 1.14-5.49). Adjustment for primary kidney disease reduced the effect of Asian background, suggesting that part of the association may be explained by differences in the underlying kidney disease between racial groups.
  
  
  CONCLUSIONS
  No data for socioeconomic status, blood group, and HLA profile.
  
  
  CONCLUSIONS
  We believe this is the first study examining racial differences in access to and outcomes of kidney transplantation in a large European population. We found important differences with less favorable outcomes for black and Asian patients. Further research is required to address the barriers to optimal treatment among racial minority groups.
authors.affiliation: ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands; Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam, the Netherlands. Electronic address: l.a.tjaden@amc.uva.nl.
authors.forename: Lidwien A
authors.initials: LA
authors.lastname: Tjaden
authors.affiliation: ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marlies
authors.initials: M
authors.lastname: Noordzij
authors.affiliation: ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: van Stralen
authors.affiliation: Swiss Pediatric Renal Registry, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Kuehni
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, Ghent University Hospital and Ghent University, Ghent, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Raes
authors.affiliation: Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Cornelissen
authors.affiliation: Birmingham Children's Hospital, Birmingham, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Brien
authors.affiliation: Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece.
authors.forename: Fotios
authors.initials: F
authors.lastname: Papachristou
authors.affiliation: Department of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
authors.affiliation: Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam, the Netherlands.
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Groothoff
authors.affiliation: ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005060:Europe / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000639:trends; D054625:Healthcare Disparities / Q000208:ethnology* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D016030:Kidney Transplantation / Q000639:trends; D008297:Male; D009398:Nephrology / Q000639:trends; D063505:Racism / Q000208:ethnology* / Q000639:trends; D012042:Registries; D006435:Renal Dialysis / Q000639:trends; D012955:Societies, Medical / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
keywords: Children; Europe; adolescents; ethnic minority; health disparity; health policy; immigrant; kidney transplantation; pediatric; racial disparities; renal disease; renal replacement therapy (RRT)