title: Effect of Immigration Status on Outcomes in Pediatric Kidney Transplant Recipients.
abstract: Kidney transplantation is the optimal treatment for children with end-stage renal disease. For children with undocumented immigration status, access to kidney transplantation is limited, and data on transplant outcomes in this population are scarce. The goal of the present retrospective single-center study was to compare outcomes after kidney transplantation in undocumented children with those of US citizen children. Undocumented residency status was identified in 48 (17%) of 289 children who received a kidney transplant between 1998 and 2010. In undocumented recipients, graft survival at 1 and 5 years posttransplantation was similar, and mean estimated glomerular filtration rate at 1 year was higher than that in recipients who were citizens. The risk of allograft failure was lower in undocumented recipients relative to that in citizens at 5 years posttransplantation, after adjustment for patient age, donor age, donor type, and HLA mismatch (p < 0.04). In contrast, nearly one in five undocumented recipients who reached 21 years of age lost their graft, primarily because they were unable to pay for immunosuppressive medications once their state-funded insurance had ended. These findings support the ongoing need for immigration policies for the undocumented that facilitate access to work-permits and employment-related insurance for this disadvantaged group.
authors.affiliation: Division of Transplant, Department of Surgery, University of California, San Francisco, CA.
authors.forename: M E
authors.initials: ME
authors.lastname: McEnhill
authors.affiliation: Division of Transplant, Department of Surgery, University of California, San Francisco, CA.
authors.forename: J L
authors.initials: JL
authors.lastname: Brennan
authors.affiliation: Section of Nephrology, Department of Pediatrics, University of California, Davis, CA.
authors.forename: E
authors.initials: E
authors.lastname: Winnicki
authors.affiliation: Division of Nephrology, Department of Pediatrics, University of California, San Francisco, CA.
authors.forename: M M
authors.initials: MM
authors.lastname: Lee
authors.affiliation: Division of Transplant, Department of Surgery, University of California, San Francisco, CA.
authors.forename: M
authors.initials: M
authors.lastname: Tavakol
authors.affiliation: Division of Transplant, Department of Surgery, University of California, San Francisco, CA.
authors.forename: A M
authors.initials: AM
authors.lastname: Posselt
authors.affiliation: Division of Transplant, Department of Surgery, University of California, San Francisco, CA.
authors.forename: P G
authors.initials: PG
authors.lastname: Stock
authors.affiliation: Division of Nephrology, Department of Pediatrics, University of California, San Francisco, CA.
authors.forename: A A
authors.initials: AA
authors.lastname: Portale
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004641:Emigration and Immigration / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007223:Infant; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D066027:Transplant Recipients; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult