Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States

Am J Transplant. 2013 Jul;13(7):1769-81. doi: 10.1111/ajt.12299. Epub 2013 Jun 3.


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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Age Distribution
  • Child
  • Child, Preschool
  • Continental Population Groups*
  • Ethnic Groups*
  • Female
  • Follow-Up Studies
  • Health Services Accessibility*
  • Healthcare Disparities / ethnology*
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Kidney Failure, Chronic / ethnology*
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / ethnology*
  • Living Donors
  • Male
  • Retrospective Studies
  • Risk Factors
  • Sex Distribution
  • Socioeconomic Factors
  • United States / epidemiology
  • Waiting Lists