Racial and ethnic disparities in pediatric renal allograft survival in the United States.

TitleRacial and ethnic disparities in pediatric renal allograft survival in the United States.
Publication TypeJournal Article
Year of Publication2015
AuthorsPatzer RE, Mohan S, Kutner N, McClellan WM, Amaral S
JournalKidney Int
Volume87
Issue3
Pagination584-92
Date Published2015 Mar
ISSN1523-1755
KeywordsAdolescent, African Americans, Allografts, Child, Child, Preschool, European Continental Ancestry Group, Female, Graft Rejection, Graft Survival, Health Status Disparities, Hispanic Americans, Humans, Infant, Infant, Newborn, Kidney Failure, Chronic, Kidney Transplantation, Living Donors, Male, Medicare, Poverty Areas, Survival Rate, 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.

DOI10.1038/ki.2014.345
Alternate JournalKidney Int.
PubMed ID25337773
PubMed Central IDPMC4344895
Grant ListK23-DK083529 / DK / NIDDK NIH HHS / United States
KL2TR000455 / TR / NCATS NIH HHS / United States
L60 MD007236 / MD / NIMHD NIH HHS / United States
R24 MD008077 / MD / NIMHD NIH HHS / United States
R24MD008077 / MD / NIMHD NIH HHS / United States
ULL TR000454 / TR / NCATS NIH HHS / United States